The management of low-risk primary upper gastrointestinal haemorrhage in the community: a 5-year observational study

Cara McLaughlin, Louisa Vine, Luke Chapman, Paula Deering, Sam Whittaker, John Beckly, Paul Fortun, Iain A Murray, S Hyder Hussaini, Nick P Michell, Bill Stableforth, Peter Thatcher, Nicola C Hare, Jo Palmer, Harry R Dalton
European Journal of Gastroenterology & Hepatology 2012, 24 (3): 288-93

BACKGROUND: Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.

AIM: To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.

METHODS: Prospective/retrospective study of all patients presenting to a UK teaching hospital with low-risk upper gastrointestinal haemorrhage who were managed without admission to hospital over 5 years. Low risk was defined as Glasgow Blatchford Score of 2 or less, age below 70 years, no other active medical problems, not taking warfarin and suspected nonvariceal bleed. Outcome measures were the need for intervention (blood transfusion, endoscopic therapy or surgery) and death.

RESULTS: One hundred and forty-two patients fulfilled the inclusion criteria, and were managed without admission to hospital. No patients required endoscopic intervention, blood transfusion or surgery. The 28-day mortality was nil. Forty-one patients had normal endoscopic examination and 11 had significant endoscopic findings (peptic ulceration=10, oozing Mallory-Weiss tear=1) but did not require intervention.

CONCLUSION: Patients presenting with a primary upper gastrointestinal haemorrhage aged below 70 years with a Glasgow Blatchford Score of 2 or less are at a low risk, and can be safely managed in the community.

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