Unifying Concepts

Criteria for Acute Upper Gastrointestinal Hemorrhage

Acute upper gastrointestinal (GI) bleeding is common and potentially life-threatening and needs a prompt assessment and aggressive medical management. All patients need to undergo endoscopy to diagnose, assess, and possibly treat any underlying lesion.

Criteria for Acute Upper Gastrointestinal Hemorrhage
Acute upper gastrointestinal hemorrhage must meet at least one of the following criteria:

  • Hematemesis, defined as either
    • >/= 1 Episode of vomiting either fresh blood or a coffee-grounds–like material, witnessed by medical or nursing personnel OR
    • A history of >/= 1 episode of fresh blood or coffee-grounds emesis, along with either
      • Hypotension (systolic BP <100 mm Hg), orthostasis (>/= 20 mm Hg decline in systolic BP from lying supine to standing or a decline of >/= 10 mm Hg from lying supine to sitting, or an increase in heart rate of >/= 20/min from lying supine to standing, or an increase in heart rate of >/= 10/min from lying supine to sitting) OR
      • New anemia (hemoglobin or hematocrit level lower than the lower limit of normal and not previously documented in the medical record) or observed melena
  • Reported or observed melena with a diagnostic EGD
  • Reported hematemesis with a diagnostic EGD
  • Observed or reported hematochezia with nasogastric aspirate of fresh or dark blood

Abbreviations: BP, blood pressure; EGD, esophagogastroduodenoscopy.



  1. Imperiale TF, Dominitz JA, Provenzale DT, Boes LP, Rose CM, Bowers JC, Musick BS, Azzouz F, Perkins SM. Predicting poor outcome from acute upper gastrointestinal hemorrhage. Arch Intern Med. 2007 Jun 25;167(12):1291-6. [Medline]
  2. Rockall TA, Logan RF, Devlin HB, Northfield TC. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet. 1996 Apr 27;347(9009):1138-40. [Medline]


Created Jul 14, 2011.

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