[Early discharge possible in acute upper gastrointestinal bleeding; new study results require adaptation of Dutch...

Acute upper gastrointestinal bleeding is still an important emergency situation with an incidence of 48-62 per 100,000 adults per year in the Netherlands. An international multicentre prospective study evaluated different risk scoring systems for patients presenting with upper gastrointestinal bleeding. The authors showed that patients with a Glasgow Blatchford score of 0 or 1 could be safely discharged without endoscopy. Thirty-day all-cause mortality in this group was 0.4%. In the current Dutch guideline, there is no clear advice on management of low-risk patients. The new guideline is expected in 2017 and should include this clear advice of discharging low-risk patients (Glasgow Blatchford score ≤ 1). It can therefore be concluded that with optimal selection about 20% of all patients presenting to the emergency room with acute upper gastrointestinal bleeding can be discharged the same day without intervention.