Tomáš Koller
Management of acute upper gastrointestinal tract (GIT) bleeding starts with detailed medical history. All risk factors for
bleeding should be explored, namely the history of the liver and kidney disease as well as drug history. This is followed
by blood loss estimation using the general status and physical examination of the patient. The risk of death could be
evaluated using a validated clinical Rockall score. Urgent care for patients with acute upper GIT bleeding is specialty independent
and should aim at hemodynamic stabilization using initial volume substitution. Red blood cells should be
substituted cautiously, but blood coagulation and platelet disorders should be promptly and effectively corrected. The
timing of endoscopy depends on the risk profile of a particular patient with high-risk patients scoped within 12 hours of
admission. Early endoscopy should only be done in patients with empty stomach, that are hemodynamicly stable and
cooperating, and by an experienced endoscopist with adequate equipment. Once the bleeding lesion is identified and
treated, a follow-up management includes treatment with proton-pump inhibitors or vasoactive drugs, further haemodynamic
stabilization and screening and treatment of H. Pylori infection.