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Date issued: December 2022 

Review date: December 2024

Ref: A-569/NB/ED/Upper Gastrointestinal Bleeding Advice for adults

PDF:  Upper Gastrointestinal Bleeding Advice for adults final December 2022.pdf [pdf] 149KB

What is a low-risk upper gastrointestinal bleed?

Passing very dark, tarry stool, vomiting blood or altered blood (sometimes looks like coffee grounds) are signs that you may be bleeding from your stomach or gut.  This can happen for a variety of reasons such as an ulcer, too much alcohol ingestion or after being violently sick.  If you have been assessed as being “low risk” in the Emergency Department or on the Ambulatory Care Unit your episode of bleeding is unlikely to cause you any further trouble and it is safe for you to go home with no further investigations at this point.

Is it ok for me to go home?

We think that it is all right for you to leave hospital now.  We have checked your symptoms, vital signs and some blood tests and it is fine for you to go home rather than having to stay in hospital. 

When you get home, it is very unlikely that you will have any further problems.  We would like you to see your GP within the next 5 days to discuss your attendance today and to decide whether you will need any further investigations such as an endoscopy (where a flexible telescope is used to examine your stomach and oesophagus). 

The majority of patients need no further investigations.  If your GP believes that an endoscopy is indicated, then s/he can arrange this directly.

What signs can I look for at home?

If any of these problems occur, we suggest you come back to the Emergency Department, or arrange to see your GP, as soon as possible:

• Further episode of vomiting blood / altered blood (looks like coffee grounds) or passing very dark, tarry stool

• Any fainting/ feeling faint episodes

• Any ongoing abdominal pain

What can I do to help myself?

• Avoid drinking more than the recommended maximum amount of alcohol per day (3-4 units for men and 2-3 units for women with 2 alcohol-free days every week).

• Stop smoking, support is available through your GP or Practice Nurse

• Visit your GP soon to discuss today’s events further and to explore other lifestyle factors.

Can I take painkillers?

Yes.  Painkillers such as paracetamol are useful to ease abdominal pain.  It would be wise to avoid non-steroidal anti-inflammatories, such as Nurofen™, ibuprofen and diclofenac, until you have spoken to your GP.

Will I have any long-term problems?

Most patients who have been discharged on the same day following a possible upper gastrointestinal bleed recover quickly from their episode and have no long-term problems.  However, a small number of patients may go on to have further bleeds.

If you start to feel that things are not quite right (e.g. ongoing abdominal pain, vomiting or dark stools or unexplained weight loss), then please contact your GP as soon as possible so that he/she can make sure you are recovering properly.  In an emergency then call 999.

This guideline has been written with reference to NICE Guideline 141 “Acute Upper Gastrointestinal Bleeding in Over 16s”.