Evaluation of Upper Gastrointestinal Bleeding

Patient Assessment and Risk Factors

• The American Gastroenterological Association recommends quantifying abdominal pain characteristics, including location, relationship to meals, and duration, to assess patients with upper gastrointestinal bleeding 1, 2
• The European Society of Gastrointestinal Endoscopy suggests screening for NSAID use, aspirin, anticoagulants, or alcohol excess, as these are major risk factors for gastroduodenal bleeding 3

Physical Examination and Diagnostic Investigations

• The American College of Gastroenterology recommends assessing for peritoneal signs, which would indicate perforation requiring emergency surgery 4
• The National Institute for Health and Care Excellence suggests ordering liver function tests and lipase to evaluate for hepatobiliary or pancreatic pathology 5

Differential Diagnoses and Management

• The American Gastroenterological Association recommends considering functional dyspepsia, H. pylori infection, and medication-induced gastropathy as alternative diagnoses in patients with upper gastrointestinal bleeding 1, 2, 3, 6
• The European Society of Gastrointestinal Endoscopy suggests testing for H. pylori and treating if positive, and discontinuing NSAIDs permanently if possible, in patients with peptic ulcer disease 3, 6