Patient handout

Upper GI Bleeding

PRODUCTION

1. Your condition

This handout is for upper gi bleeding. Your care team identified this based on: hematemesis (red blood or coffee-ground).

Other reasons your team may use this plan: melena (black tarry stools); syncope / presyncope with gi blood loss; acute drop in hemoglobin / elevated bun:cr.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
normal_saline_or_LR	500-1000 mL IV bolus then titrate	IV	per response	Initial volume resuscitation; LR generally preferred over NS in massive resuscitation (ACG 2021 Laine; ESGE 2021)
packed_red_blood_cells	1-2 units	IV	per response	Restrictive transfusion threshold Hgb <7 (TRIGGER/Villanueva 2013); <8 if ACS/CAD

Plan: UGIB acute regimen — non-variceal vs variceal pathways (ACG 2021 + Baveno VII)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Glasgow-Blatchford Score >=6 on arrival (ACG 2021 Laine)
SBP <90 or HR >110 persistent despite 2L crystalloid + initial transfusion (ACG 2021 Laine)(life-threatening)
Hematemesis + known cirrhosis OR stigmata of chronic liver disease (Baveno VII 2022)
Massive UGIB in patient with prior aortic graft or AAA repair (ACG 2021 Laine)(life-threatening)
Active UGIB on warfarin INR >1.5 or DOAC or recent thrombolysis (ACG 2021 Laine)
Hgb drop >=2 g/dL OR recurrent hematemesis or melena within 72h of index EGD (ACG 2021 Laine)

5. Follow-up

Repeat EGD 6-8w for ulcer/malignancy; HP eradication confirmation 4w; variceal band ligation series q2-4w + secondary NSBB prophylaxis; anticoag resumption with cardiology; GI clinic 2-4w; iron studies

6. Sources

Guideline: ACG 2021 UGIB (Laine) + ESGE 2021 Non-variceal UGIB + Baveno VII 2022 Portal HTN + NICE NG141 (2024 update) + TRIGGER 2015 + HALT-IT 2020 + ABOVE 2024 + PLACE 2024