ICU · GI & nutrition / surgical

Upper GI Bleed — Variceal & Non-Variceal — Resuscitation, Risk Scores & the Endoscopic Bundle

Also known as Upper GI bleed · UGIB · Haematemesis · Melaena · Variceal bleed · Non-variceal bleed · Peptic ulcer bleed · Glasgow-Blatchford score · Rockall score · Terlipressin · Octreotide · Band ligation · TIPS · Proton pump inhibitor infusion · TRIGGER trial · Ceftriaxone prophylaxis

Upper GI bleeding is the haematemesis or melaena from a source proximal to the ligament of Treitz. The first decision is resuscitation (airway protection with early intubation in the encephalopathic, restrictive transfusion — transfuse when haemoglobin falls below 70 g/L, post-transfusion target 70-90 g/L per ESGE) followed by the variceal versus non-variceal fork. Non-variceal (peptic ulcer, Mallory-Weiss) — after endoscopic haemostasis a high-dose PPI infusion (e.g. omeprazole 80 mg bolus then 8 mg/h for 72 hours), endoscopy within 24 h with dual endoscopic therapy for active bleeding (epinephrine injection plus a second thermal or mechanical modality), H. pylori eradication and early aspirin resumption. Variceal (cirrhosis) — the time-limited BUNDLE of vasoactive drug (terlipressin, octreotide or somatostatin, e.g. octreotide 50 mcg bolus then 50 mcg/h) PLUS prophylactic antibiotic (ceftriaxone 1 g/day for up to 7 days) PLUS endoscopic evaluation within 12 hours with band ligation, with pre-emptive TIPS within 72 hours for the high-risk subgroup (Child-Pugh C or Child-Pugh B above 7 with active bleeding).

Checked against its sources on 13 Oct 2026