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Acute upper gastrointestinal bleeding: a guide for nurses

10 January 2019
Volume 28 · Issue 1


This article outlines latest evidence-based care for patients with acute upper gastrointestinal (GI) bleeding. It aims to help gastroenterology and general medical ward nurses plan nursing interventions and understand the diagnostic treatment options available. Acute upper GI bleeding can present as variceal or non-variceal bleeding and has a high death rate. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed. Various therapies can be initiated at endoscopy, depending on the source of bleeding. If bleeding continues in spite of these therapies, further interventions such as the Sengstaken tube, oesophageal stents, radiological or surgical treatments may be required. After endoscopy, it is important to have a plan for ongoing treatment. Patients may require acid suppression treatment or eradication of Helicobacter pylori as part of their treatment plan. They may in additional require correction of their haemoglobin levels and follow-up endoscopy. It is essential that nurses caring for such patients are aware of the current UK guidance and help patients to adhere to agreed treatment plans.

Acute upper gastrointestinal (GI) bleeding is a common medical emergency with an estimated incidence of 134 per 100 000 population (Button et al, 2011). It occurs above the ligament of Treitz, the boundary between the duodenum and the jejunum. National guidelines have been produced by the National Institute for Health and Care Excellence (NICE) (2012) and by a collaboration between the Scottish Intercollegiate Guidelines Network (SIGN) and the British Society of Gastroenterology (SIGN, 2008) to improve patient outcomes. However, the 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2015) review on patients with acute upper GI bleeding found variable practice and less than adequate standards of care. Consequently, NCEPOD proposed a set of criteria to standardise practice (NCEPOD, 2015: 97-98). Despite these, it is noteworthy that guidance specific to nursing care is lacking, and yet it is essential that nurses caring for patients with acute GI bleeding are aware of the current standards to ensure optimal care.

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