Initial management of nonvariceal upper gastrointestinal bleeding and timing of endoscopy

Acute nonvariceal upper gastrointestinal bleeding is a common cause of hospital admission with significant associated health care expenditures and a significant but improving mortality rate. Initial management includes proper resuscitation with close hemodynamic monitoring, a blood transfusion threshold of 7 g/dL in most patients, early risk stratification using validated prognostic scores, and timely upper endoscopy. Current guidelines recommend that upper endoscopy be performed within 24 hours of presentation, except for patients at very low risk of adverse outcomes who may undergo more elective upper endoscopy. The role of urgent endoscopy for patients at higher risk for adverse outcomes remains controversial.