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Twitter debate: controversies in management of upper gastrointestinal bleeding
  1. Carly Lamb1,
  2. James Maurice2,
  3. Adrian J Stanley1
  1. 1 GI Unit, Glasgow Royal Infirmary, Glasgow, UK
  2. 2 Hepatology, Imperial College, London, UK
  1. Correspondence to Dr Carly Lamb, Medicine, Glasgow Royal Infirmary, Glasgow G4 0SF, UK; carly.lamb{at}nhs.scot

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Introduction

The latest in the series of ‘Controversies in…’ Twitter debates for Frontline Gastroenterology was led by AJS (@AdrianStanleyGI) in a discussion on the topic of acute upper gastrointestinal bleeding (UGIB). This remains a medical emergency that is frequently encountered by both general physicians and gastroenterologists, with in-hospital mortality of approximately 10%.1 A previous Frontline Gastroenterology debate ‘controversies in the management of portal hypertension’, covered updates in variceal bleeding.2 This article summarises current controversies and recent published research in the management of non-variceal UGIB.

Pre-endoscopy management

Risk scores: which score to use and does it alter clinical management?

The debate began with an evaluation of the clinical utility of risk scoring systems in the assessment of UGIB. The Glasgow Blatchford score (GBS) is now the scoring system recommended by all the major recent international guidelines for identifying patients with very low-risk UGIB (GBS 0–1) who can be considered for outpatient management.3–5 Use of this score by clinicians in the emergency department (ED) or acute medical receiving unit allows early identification of low-risk patients who can avoid admission and have outpatient endoscopy arranged. The GBS gives junior doctors and our ED colleagues’ confidence to facilitate prompt decision making and avoid unnecessary hospital admissions.

In 2019, Shung et al used machine learning to develop a model that was able to identify patients admitted with UGIB who were at risk of requiring hospital-based intervention or death.6 This was found to have greater specificity and sensitivity than all the current clinical risk scoring systems. Further data on the clinical utility of this …

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Footnotes

  • Twitter @jamesbmaurice

  • Contributors All authors contributed to and approved the final manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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