Severe UGIB

• Differentiating between upper and lower GIB can be challenging. 
• A recent review evaluated the accuracy of historical features, symptoms, signs, and lab values in distinguishing between UGIB and LGIB. 
• Features with the highest likelihood for identifying UGIB included:
  • Melenic stool on exam (LR 25)
  • A prior history of UGIB (LR 6.2)
  • Serum urea:creatinine ratio > 30 (LR 7.5)
• Features that increased the likelihood of severe UGIB (defined as requiring blood transfusion, need for urgent endoscopy, surgery, or interventional radiology) included:
  • Heart rate > 100 bpm (LR 4.9)
  • Hemoglobin < 8 g/dL (LR 6.2)
  • History of cirrhosis or cancer (LR 3.7)
• For patients with an UGIB, the Blatchford Score can be used to determine the need for urgent intervention.  Those with a Blatchford Score of 0 have a low likelihood for severe UGIB and may not need emergent intervention.

References

Srygley FD, et al. Does this patient have a severe upper gastrointestinal bleed? JAMA 2012;307:1072-9.