GI bleeding
Also known as: LGIB · lower GI bleed · UGIB · upper GI bleed · variceal bleeding
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ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding
American College of Gastroenterology (ACG) · 2021
This ACG guideline covers management of overt upper gastrointestinal bleeding including bleeding peptic ulcers, from risk stratification through endoscopic therapy and post-endoscopy acid suppression.
- The guideline recommends risk stratification in the emergency department to identify very-low-risk patients suitable for outpatient follow-up. source
- It addresses transfusion thresholds, timing of endoscopy, endoscopic haemostasis techniques and high-dose proton pump inhibitor therapy after haemostasis. source
Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): ESGE Guideline – Update 2021
ESGE (European Society of Gastrointestinal Endoscopy) · 2021 · Update 2021
ESGE's updated guideline covers endoscopic diagnosis and treatment of non-variceal upper gastrointestinal haemorrhage, including pre-endoscopy risk assessment, acid suppression and choice of haemostatic technique.
US vs EU key differences
- The two converge on triage and timing: both use a Glasgow-Blatchford score of 0-1 to identify very-low-risk patients suitable for outpatient management, and both recommend endoscopy within 24 hours of presentation rather than urgent endoscopy within 12 hours. source
- Post-endoscopy PPI regimens differ in preference: ESGE favours an intravenous bolus followed by continuous infusion for 72 hours, while the ACG guideline accepts continuous or intermittent high-dose PPI for 3 days and then specifies twice-daily oral PPI for the following 2 weeks. source
- Hemostatic powder is positioned differently: the ACG guideline suggests TC-325 for actively bleeding ulcers, whereas ESGE reserves topical hemostatic powder and cap-mounted clips for cases where conventional endoscopic hemostasis fails. source
- The European guideline gives concrete antithrombotic timing rules, including not stopping cardioprotective low-dose aspirin (or restarting within 3-5 days) and resuming anticoagulation around 7 days after bleeding control. source
What changed recently
- US2012 → 20212021-05-01
The 2021 ACG guideline withdrew the 2012 suggestion that pre-endoscopic PPI may be considered, making no recommendation either way after meta-analysis showed no effect on rebleeding or mortality. It also widened the very-low-risk group eligible for discharge from the emergency department to a Glasgow-Blatchford score of 0-1 (previously 0) and specified twice-daily PPI for two weeks after endoscopic hemostasis in high-risk ulcers, while keeping the restrictive 7 g/dL transfusion threshold.
source ↗curation confidence 90% - EU2015 → Update 20212021-03-01
The 2021 ESGE update issues a strong recommendation against urgent endoscopy within 12 hours, since trial evidence showed no outcome advantage over early endoscopy performed within 24 hours of haemodynamic resuscitation. It also refreshes guidance on cap-mounted clips and topical haemostatic powders as salvage options when standard haemostasis fails.
source ↗curation confidence 90%
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