Summary of recommendation statements
| Recommendation statement | Level of evidence | Level 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. | Low | Strong |
| 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). | Low | Strong |
| 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 low | Strong |
| 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. | High | Strong |
| We recommend that patients with AUGIB with ongoing haemodynamic instability are referred for critical care review. | Very low | Strong |
| 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 low | Weak |
| We recommend the Glasgow-Blatchford Score (GBS) is calculated at presentation with AUGIB. | Moderate | Strong |
| We recommend that patients with GBS ≤1 at presentation are considered for outpatient management. | Moderate | Strong |
| 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. | High | Strong |
| We recommend giving intravenous antibiotics as per local protocol to patients with suspected cirrhosis/variceal bleeding. | High | Strong |
| We recommend continuing aspirin at presentation. | Moderate | Strong |
| 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. | Moderate | Strong |
| We recommend interrupting warfarin therapy at presentation. | Low | Strong |
| We recommend interrupting direct oral anticoagulant therapy at presentation. | Low | Strong |
| 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. | Low | Strong |
| We suggest that the endoscopy report should be reviewed by the ward team. | Very low | Strong |
| We suggest that all patients with varices or those requiring endoscopic therapy are referred to a specialist gastroenterology service. | Low | Strong |
| 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. | High | Strong |
| We recommend patients with AUGIB in whom antithrombotic therapy is interrupted have a clear plan for resumption. | Low | Strong |