Gastroenterology and hepatology
Gastrointestinal bleeding
Resuscitation, Glasgow-Blatchford and Oakland triage, endoscopy timing, variceal versus non-variceal care, and restarting antithrombotics after upper and lower GI bleeding.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Upper GI bleeding (proximal to the ligament of Treitz) presents with haematemesis, coffee-ground vomiting or melaena. It is commoner and deadlier than lower GI bleeding, with mortality around 5 to 10%.
- Lower GI bleeding presents with haematochezia. Most episodes stop on their own, and mortality is lower (about 1 to 3%), mostly from comorbidity.
- The sequence is the same for both: resuscitate, risk stratify, find and treat the source, prevent rebleeding.
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Sources
- Therapeutic Guidelines: Gastrointestinal (eTG complete)AU/NZTherapeutic Guidelines Limited
- Endoscopic diagnosis and management of peptic ulcer bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, Update 2026. Endoscopy 2026European Society of Gastrointestinal Endoscopy, 2026
- Barkun AN et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med 2019;171:805-22International Consensus Group (Annals of Internal Medicine), 2019
- Gralnek IM et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): ESGE Guideline, Update 2021. Endoscopy 2021;53:300-32European Society of Gastrointestinal Endoscopy, 2021
- Laine L et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol 2021;116:899-917American College of Gastroenterology, 2021
- Sengupta N et al. Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. Am J Gastroenterol 2023;118:208-31American College of Gastroenterology, 2023
- Oakland K et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut 2019;68:776-89British Society of Gastroenterology, 2019
- Kinjo K et al. Validation of British Society of Gastroenterology guidelines for acute lower GI bleeding from 8956 cases in Japan (CODE BLUE-J). Gastrointest Endosc 2025;101:1131-44Gastrointestinal Endoscopy, 2025
- TGA Medicine Shortage Information: andexanet alfa (Andexxa), discontinued 20 May 2026AU/NZTherapeutic Goods Administration, 2026
- Baveno VIII consensus on portal hypertension and vascular liver disease. J Hepatol 2026. doi:10.1016/j.jhep.2026.07.030Baveno Cooperation / EASL (Journal of Hepatology), 2026
- Updated recommendations for warfarin reversal in the setting of four-factor prothrombin complex concentrateAU/NZMedical Journal of Australia (Robinson, McFadyen, Merriman, Tan, Baker and Tran, 2025;222:49-51), 2025
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy