Upper GI bleeding guidelines - Revision history

Ostermayer: Prepared the page for translation

2026-01-05T00:02:53Z

Prepared the page for translation

← Revisión anterior		Revisión del 00:02 5 ene 2026
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	''See [[upper gastrointestinal bleeding]] for clinical treatment page.''		<languages/>
			<translate>
			''See [[Special:MyLanguage/upper gastrointestinal bleeding\|upper gastrointestinal bleeding]] for clinical treatment page.''


	==American College of Gastroenterology Guidelines for GI Ulcers==		==American College of Gastroenterology Guidelines for GI Ulcers==

	*Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)		*Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)

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	*Nasogastric or orogastric lavage is not required in patients with upper GI bleeding for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)		*Nasogastric or orogastric lavage is not required in patients with upper GI bleeding for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)


	==GI Ulcer Recommendation Strength of Evidence Classification==		==GI Ulcer Recommendation Strength of Evidence Classification==

	*Strong: The desirable effects of an intervention clearly outweigh the undesirable effects.		*Strong: The desirable effects of an intervention clearly outweigh the undesirable effects.
	*Conditional: Uncertainty exists about the trade-offs.		*Conditional: Uncertainty exists about the trade-offs.
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	*Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.		*Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
	*Very low: Any estimate of effect is very uncertain.		*Very low: Any estimate of effect is very uncertain.


	==American College of Gastroenterology Guidelines for Variceal Bleeding==		==American College of Gastroenterology Guidelines for Variceal Bleeding==

	*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).		*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).

	*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous [[ciprofloxacin]] (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous [[ceftriaxone]] (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).		*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous [[Special:MyLanguage/ciprofloxacin\|ciprofloxacin]] (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous [[Special:MyLanguage/ceftriaxone\|ceftriaxone]] (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).

	*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).		*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).
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	*Balloon tamponade should be used as a temporizing measure (maximum 24 hours) in patients with uncontrollable bleeding for whom a more definitive therapy (e.g., TIPS or endoscopic therapy) is planned (Class I, Level B).		*Balloon tamponade should be used as a temporizing measure (maximum 24 hours) in patients with uncontrollable bleeding for whom a more definitive therapy (e.g., TIPS or endoscopic therapy) is planned (Class I, Level B).


	==Variceal Bleeding Recommendation Strength of Evidence Classification==		==Variceal Bleeding Recommendation Strength of Evidence Classification==
	*[[Recommendation Grading System]]
			*[[Special:MyLanguage/Recommendation Grading System\|Recommendation Grading System]]


	==See Also==		==See Also==
	*[[Upper GI Bleeding]]
	*[[EBQ:Omeprazole in Bleeding Peptic Ulcers]]		*[[Special:MyLanguage/Upper GI Bleeding\|Upper GI Bleeding]]
			*[[EBQ:Omeprazole in Bleeding Peptic Ulcers\|EBQ:Omeprazole in Bleeding Peptic Ulcers]]


	==References==		==References==

	<references/>		<references/>
	*[http://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ Management of Patients with Ulcer Bleeding. March, 2012.]		*[http://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ Management of Patients with Ulcer Bleeding. March, 2012.]
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	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: Rossdonaldson1 moved page Upper GI Bleed Guidelines to Upper GI bleeding guidelines

2022-03-12T14:02:29Z

Rossdonaldson1 moved page Upper GI Bleed Guidelines to Upper GI bleeding guidelines

← Revisión anterior	Revisión del 14:02 12 mar 2022
(Sin diferencias)

Rossdonaldson1: Text replacement - " ceftriaxone " to " ceftriaxone "

2016-09-08T14:34:59Z

Text replacement - " ceftriaxone " to " ceftriaxone "

← Revisión anterior		Revisión del 14:34 8 sep 2016
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	*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).		*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).

	*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous [[ciprofloxacin]] (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).		*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous [[ciprofloxacin]] (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous [[ceftriaxone]] (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).

	*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).		*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).

Rossdonaldson1: Text replacement - "ciprofloxacin " to "ciprofloxacin "

2016-08-06T13:55:30Z

Text replacement - "ciprofloxacin " to "ciprofloxacin "

← Revisión anterior		Revisión del 13:55 6 ago 2016
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	*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).		*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).

	*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous ciprofloxacin (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).		*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous [[ciprofloxacin]] (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).

	*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).		*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-27T06:11:50Z

Text replacement - "0 mg" to "0mg"

← Revisión anterior		Revisión del 06:11 27 jul 2016
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	*In patients with higher-risk clinical features (eg, tachycardia, hypo- tension, bloody emesis, or nasogastric aspirate in hospital) endoscopy within 12 hours may be considered to potentially improve clinical outcomes. (Conditional, low-quality evidence)		*In patients with higher-risk clinical features (eg, tachycardia, hypo- tension, bloody emesis, or nasogastric aspirate in hospital) endoscopy within 12 hours may be considered to potentially improve clinical outcomes. (Conditional, low-quality evidence)

	*Intravenous infusion of erythromycin (~~250 mg~~ approximately 30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy. However, erythromycin has not consistently been shown to improve clinical outcomes. (Conditional, moderate-quality evidence)		*Intravenous infusion of erythromycin (250mg approximately 30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy. However, erythromycin has not consistently been shown to improve clinical outcomes. (Conditional, moderate-quality evidence)

	*Nasogastric or orogastric lavage is not required in patients with upper GI bleeding for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)		*Nasogastric or orogastric lavage is not required in patients with upper GI bleeding for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)
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	*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).		*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).

	*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (~~400 mg~~ BID) or intravenous ciprofloxacin (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).		*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400mg BID) or intravenous ciprofloxacin (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).

	*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).		*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).

Neil.m.young: Text replacement - "2 mg" to "2mg"

2016-07-27T03:54:11Z

Text replacement - "2 mg" to "2mg"

← Revisión anterior		Revisión del 03:54 27 jul 2016
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	==American College of Gastroenterology Guidelines for GI Ulcers==		==American College of Gastroenterology Guidelines for GI Ulcers==
	*Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.~~2 mg~~/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)		*Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)

	*Blood transfusions should target hemoglobin ≥ 7 g/dL, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or co-morbidities such as coronary artery disease. (Conditional, low-to-moderate- quality evidence)		*Blood transfusions should target hemoglobin ≥ 7 g/dL, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or co-morbidities such as coronary artery disease. (Conditional, low-to-moderate- quality evidence)

Neil.m.young: Text replacement - "* " to "*"

2016-07-10T06:26:00Z

Text replacement - "* " to "*"

Rossdonaldson1 at 01:21, 18 March 2016

2016-03-18T01:21:43Z

← Revisión anterior		Revisión del 01:21 18 mar 2016
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			''See [[upper gastrointestinal bleeding]] for clinical treatment page.''

	==American College of Gastroenterology Guidelines for GI Ulcers==		==American College of Gastroenterology Guidelines for GI Ulcers==
	* Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2 mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)		* Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2 mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)

Neil.m.young at 22:34, 4 September 2015

2015-09-04T22:34:22Z

← Revisión anterior		Revisión del 22:34 4 sep 2015
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	==See Also==		==See Also==
	*[[Upper GI Bleeding]] ~~<br/>~~		*[[Upper GI Bleeding]]
	*[[EBQ:Omeprazole in Bleeding Peptic Ulcers]]		*[[EBQ:Omeprazole in Bleeding Peptic Ulcers]]

	~~[[Category:GI]]~~

	==References==		==References==
			<references/>
	* [http://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ Management of Patients with Ulcer Bleeding. March, 2012.]		* [http://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ Management of Patients with Ulcer Bleeding. March, 2012.]

	* [http://gi.org/guideline/prevention-and-management-of-gastroesophageal-varices-and-variceal-hemorrhage-in-cirrhosis/ Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. September, 2007.]		* [http://gi.org/guideline/prevention-and-management-of-gastroesophageal-varices-and-variceal-hemorrhage-in-cirrhosis/ Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. September, 2007.]

	~~<references/>~~		[[Category:GI]]

Catierey: formatting

2015-09-04T22:29:16Z

formatting

← Revisión anterior		Revisión del 22:29 4 sep 2015
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	==See Also==		==See Also==
	[[Upper GI Bleeding]]		*[[Upper GI Bleeding]] <br/>
	[[EBQ:Omeprazole in Bleeding Peptic Ulcers]]		*[[EBQ:Omeprazole in Bleeding Peptic Ulcers]]

	[[Category:GI]]		[[Category:GI]]

← Revisión anterior		Revisión del 06:26 10 jul 2016
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	==American College of Gastroenterology Guidelines for GI Ulcers==		==American College of Gastroenterology Guidelines for GI Ulcers==
	* Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2 mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)		*Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2 mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)

	* Blood transfusions should target hemoglobin ≥ 7 g/dL, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or co-morbidities such as coronary artery disease. (Conditional, low-to-moderate- quality evidence)		*Blood transfusions should target hemoglobin ≥ 7 g/dL, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or co-morbidities such as coronary artery disease. (Conditional, low-to-moderate- quality evidence)

	* Pre-endoscopic IV PPI (eg, 80-mg bolus followed by 8-mg/h infusion) may be considered to decrease the proportion of patients who have higher-risk stigmata of hemorrhage at endoscopy and who receive endoscopic therapy. However, proton pump inhibitors do not improve clinical outcomes such as further bleeding, surgery, or death. (Conditional, high-quality evidence)		*Pre-endoscopic IV PPI (eg, 80-mg bolus followed by 8-mg/h infusion) may be considered to decrease the proportion of patients who have higher-risk stigmata of hemorrhage at endoscopy and who receive endoscopic therapy. However, proton pump inhibitors do not improve clinical outcomes such as further bleeding, surgery, or death. (Conditional, high-quality evidence)

	* If endoscopy will be delayed or cannot be performed, an IV PPI is recommended to reduce further bleeding. (Conditional, moderate-quality evidence)		*If endoscopy will be delayed or cannot be performed, an IV PPI is recommended to reduce further bleeding. (Conditional, moderate-quality evidence)

	* Patients with upper GI bleeding should generally undergo endoscopy within 24 hours of admission, following resuscitative efforts to optimize hemodynamic parameters and other medical problems. (Conditional, low-quality evidence)		*Patients with upper GI bleeding should generally undergo endoscopy within 24 hours of admission, following resuscitative efforts to optimize hemodynamic parameters and other medical problems. (Conditional, low-quality evidence)

	* In patients who are hemodynamically stable and without serious co-morbidities, endoscopy should be performed as soon as possible in a non-emergent setting to identify the substantial proportion of patients with low-risk endoscopic findings who can be safely discharged. (Conditional, moderate-quality evidence)		*In patients who are hemodynamically stable and without serious co-morbidities, endoscopy should be performed as soon as possible in a non-emergent setting to identify the substantial proportion of patients with low-risk endoscopic findings who can be safely discharged. (Conditional, moderate-quality evidence)

	* In patients with higher-risk clinical features (eg, tachycardia, hypo- tension, bloody emesis, or nasogastric aspirate in hospital) endoscopy within 12 hours may be considered to potentially improve clinical outcomes. (Conditional, low-quality evidence)		*In patients with higher-risk clinical features (eg, tachycardia, hypo- tension, bloody emesis, or nasogastric aspirate in hospital) endoscopy within 12 hours may be considered to potentially improve clinical outcomes. (Conditional, low-quality evidence)

	* Intravenous infusion of erythromycin (250 mg approximately 30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy. However, erythromycin has not consistently been shown to improve clinical outcomes. (Conditional, moderate-quality evidence)		*Intravenous infusion of erythromycin (250 mg approximately 30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy. However, erythromycin has not consistently been shown to improve clinical outcomes. (Conditional, moderate-quality evidence)

	* Nasogastric or orogastric lavage is not required in patients with upper GI bleeding for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)		*Nasogastric or orogastric lavage is not required in patients with upper GI bleeding for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)

	==GI Ulcer Recommendation Strength of Evidence Classification==		==GI Ulcer Recommendation Strength of Evidence Classification==
	* Strong: The desirable effects of an intervention clearly outweigh the undesirable effects.		*Strong: The desirable effects of an intervention clearly outweigh the undesirable effects.
	* Conditional: Uncertainty exists about the trade-offs.		*Conditional: Uncertainty exists about the trade-offs.

	* High: Further research is very unlikely to change our confidence in the estimate of effect.		*High: Further research is very unlikely to change our confidence in the estimate of effect.
	* Moderate: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.		*Moderate: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
	* Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.		*Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
	* Very low: Any estimate of effect is very uncertain.		*Very low: Any estimate of effect is very uncertain.

	==American College of Gastroenterology Guidelines for Variceal Bleeding==		==American College of Gastroenterology Guidelines for Variceal Bleeding==
	* Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).		*Acute GI hemorrhage in a patient with cirrhosis is an emergency that requires prompt attention with intravascular volume support and blood transfusions, being careful to maintain a hemoglobin of ~8 g/dL (Class I, Level B).

	* Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400 mg BID) or intravenous ciprofloxacin (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).		*Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage (Class I, Level A). Oral norfloxacin (400 mg BID) or intravenous ciprofloxacin (in patients in whom oral administration is not possible) is the recommended antibiotic (Class I, Level A). In patients with advanced cirrhosis intravenous ceftriaxone (1 g/day) may be preferable particularly in centers with a high prevalence of quinolone-resistant organisms (Class I, Level B).

	* Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).		*Pharmacological therapy (somatostatin or its analogues octreotide and vapreotide; terlipressin) should be initiated as soon as variceal hemorrhage is suspected and continued for 3–5 days after diagnosis is confirmed (Class I, Level A).

	* EGD, performed within 12 hours, should be used to make the diagnosis and to treat variceal hemorrhagey (Class I, Level A).		*EGD, performed within 12 hours, should be used to make the diagnosis and to treat variceal hemorrhagey (Class I, Level A).

	* Balloon tamponade should be used as a temporizing measure (maximum 24 hours) in patients with uncontrollable bleeding for whom a more definitive therapy (e.g., TIPS or endoscopic therapy) is planned (Class I, Level B).		*Balloon tamponade should be used as a temporizing measure (maximum 24 hours) in patients with uncontrollable bleeding for whom a more definitive therapy (e.g., TIPS or endoscopic therapy) is planned (Class I, Level B).

	==Variceal Bleeding Recommendation Strength of Evidence Classification==		==Variceal Bleeding Recommendation Strength of Evidence Classification==
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	==References==		==References==
	<references/>		<references/>
	* [http://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ Management of Patients with Ulcer Bleeding. March, 2012.]		*[http://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ Management of Patients with Ulcer Bleeding. March, 2012.]
	* [http://gi.org/guideline/prevention-and-management-of-gastroesophageal-varices-and-variceal-hemorrhage-in-cirrhosis/ Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. September, 2007.]		*[http://gi.org/guideline/prevention-and-management-of-gastroesophageal-varices-and-variceal-hemorrhage-in-cirrhosis/ Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. September, 2007.]

	[[Category:GI]]		[[Category:GI]]