Know Your Guidelines Series

The ACG Clinical Practice Guideline on Upper Gastrointestinal and Ulcer Bleeding Review

Daniel R. Wells, MD; Desirée C. Burroughs-Ray, MD, MPH; Amanda V. Hardy, MD; Christopher D. Jackson, MD


South Med J. 2022;115(6):358-359. 

In This Article

Abstract and Introduction


Gastrointestinal bleeding (GIB) is a common cause of hospitalization. Upper gastrointestinal bleeding (UGIB) is a serious condition defined as bleeding that originates in the esophagus, stomach, or duodenum. Eighty percent of patients with UGIB seen in the emergency department (ED) require admission to the hospital. The 2021 American College of Gastroenterology Clinical Guidelines provides recommendations on risk stratification, preendoscopic therapy, endoscopy timing and techniques, and recurrent UGIB.[1] The guideline offers 16 statements, which we consolidated into five recommendations for this guideline update for the generalist. Based on the outcome of further bleeding, each statement received a designation of strong or conditional to characterize the level of confidence in outcome attainment. Strong recommendations begin with "we recommend" in the guideline, whereas conditional recommendations begin with "we suggest." The certainty with each recommendation was assessed as high, moderate, or low based on confidence in the effect estimate. We chose these recommendations as those that reinforced or would significantly change the clinical practice of practitioners taking care of patients with GIB. We organized these recommendations into three categories: risk stratification, preendoscopic therapy/endoscopic timing, and postendoscopic care.