ICU · GI and nutrition

Acute severe upper GI bleeding: Glasgow-Blatchford, endoscopy, and TIPSS

Also known as Upper GI bleed · UGIB · Glasgow-Blatchford score · Rockall score · Variceal bleed · Non-variceal bleed · TIPSS

Acute upper GI bleeding (UGIB) is a common ICU emergency. CLASSIFICATION: VARICEAL (portal hypertension — cirrhosis — oesophageal/gastric varices — 20%) vs NON-VARICEAL (peptic ulcer 50%, Mallory-Weiss, gastritis, malignancy, angiodysplasia — 80%). RISK STRATIFICATION: Glasgow-Blatchford Score (GBS — pre-endoscopy — identifies low-risk for outpatient; high-risk for ICU/endoscopy). MANAGEMENT: (1) RESUSCITATE (ABC, 2 large-bore IV, fluids/blood — restrictive transfusion Hb 70; intubate if encephalopathic/active haematemesis). (2) PROTON PUMP INHIBITOR (PPI — high-dose IV bolus + infusion e.g. pantoprazole 80 mg then 8 mg/hr for 72 h AFTER endoscopic haemostasis — reduces rebleeding; not a routine pre-endoscopy reflex). (3) ENDOSCOPY within 24 HOURS (diagnostic + therapeutic — adrenaline injection + thermal/clips for ulcers; band ligation for varices). (4) VARICEAL-SPECIFIC: vasoactive (terlipressin/octreotide/somatostatin — started at presentation), prophylactic antibiotics (cirrhotics — ceftriaxone), TIPSS (transjugular intrahepous portosystemic shunt) for refractory and pre-emptively in high-risk. (5) RED FLAG TRANSFUSION (massive transfusion protocol if exsanguinating). MORTALITY: 2-10% overall (non-variceal); variceal worse, reflects cirrhosis severity.