Table 1

Summary of recommendation statements

Recommendation statementLevel of evidenceLevel of recommendation
We recommend that patients with haematemesis, melaena, or coffee ground vomiting in the absence of an alternate diagnosis (eg, bowel obstruction) trigger the acute upper gastrointestinal bleeding (AUGIB) bundle.LowStrong
We recommend that patients with suspected AUGIB should have urgent observations performed using a validated early warning score such as the National Early Warning Score (NEWS).LowStrong
We recommend all patients with AUGIB be commenced on intravenous fluids. We recommend in haemodynamically unstable patients a crystalloid solution as a bolus of 500 mL in less than 15 min.Very lowStrong
We recommend that red blood cell transfusion should follow a restrictive protocol (trigger: Hb <70 g/L; target: 70–100 g/L). A higher trigger should be considered in patients with ischaemic heart disease or haemodynamic instability.HighStrong
We recommend that patients with AUGIB with ongoing haemodynamic instability are referred for critical care review.Very lowStrong
We suggest that platelets should be given in active acute upper GI bleeding with a platelet count ≤50×109/L, as per major haemorrhage protocols.Very lowWeak
We recommend the Glasgow-Blatchford Score (GBS) is calculated at presentation with AUGIB.ModerateStrong
We recommend that patients with GBS ≤1 at presentation are considered for outpatient management.ModerateStrong
We recommend intravenous terlipressin is given to all patients with suspected cirrhosis/variceal bleeding. However, caution should be exercised in patients with ischaemic heart disease or peripheral vascular disease.HighStrong
We recommend giving intravenous antibiotics as per local protocol to patients with suspected cirrhosis/variceal bleeding.HighStrong
We recommend continuing aspirin at presentation.ModerateStrong
We recommend interrupting P2Y12 inhibitors until haemostasis is achieved unless the patient has coronary artery stents, in which case, a decision should be undertaken after discussion with a cardiologist.ModerateStrong
We recommend interrupting warfarin therapy at presentation.LowStrong
We recommend interrupting direct oral anticoagulant therapy at presentation.LowStrong
We recommend endoscopy is offered to patients admitted with suspected AUGIB within 24 hours of presentation. Patients with ongoing haemodynamic instability will require more urgent endoscopy after resuscitation.LowStrong
We suggest that the endoscopy report should be reviewed by the ward team.Very lowStrong
We suggest that all patients with varices or those requiring endoscopic therapy are referred to a specialist gastroenterology service.LowStrong
We recommend patients with bleeding from ulcers with high-risk stigmata at endoscopy receive high-dose intravenous proton pump inhibitor (PPI) therapy; high-dose oral PPIs may be considered as an alternative.HighStrong
We recommend patients with AUGIB in whom antithrombotic therapy is interrupted have a clear plan for resumption.LowStrong