Deficiencies in services for acute upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding is a common and serious medical emergency. There are an estimated 50 000-70 000 hospital admissions in the United Kingdom a year1 2and overall mortality is about 10%.3 A new report by the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) identifies continuing difficulties in the provision of services for patients with substantial bleeding,4 reinforcing earlier findings from national audits5 and NHS England.6 The report focuses on patients with severe bleeding who require transfusion of at least four units of blood.

The optimum management of acute upper gastrointestinal bleeding requires a combination of circulatory resuscitation, risk assessment to help predict the need for intervention as well as outcome, administration of blood products, drug treatment, upper gastrointestinal endoscopy with haemostatic endotherapy, interventional radiology, and surgery when necessary.1 The NCEPOD report highlights deficiencies in each of these areas.

According to national audits, mortality from acute upper gastrointestinal bleeding fell in the UK between 1993-47 and 20073; the reduction was attributed, at least in part, to …