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Acute upper gastrointestinal bleeding in the UK: 2022 audit update.

Gaurav B Nigam¹, Kathryn Oakland², Sarah Hearnshaw³

¹Translational Gastroenterology and Liver Unit, Oxford University Hospitals NHS Trust, Oxford, UK gaurav.nigam@ouh.nhs.uk acdouds@gmail.com.

|November 19, 2025

Summary

Outcomes for acute upper gastrointestinal bleeding (AUGIB) have improved despite sicker patients and guideline non-adherence. Restrictive transfusion practices are crucial, as liberal transfusions above 80 g/L in stable patients increased mortality.

Keywords:

AUDIT ENDOSCOPY GASTROINTESTINAL BLEEDING GASTROINTESTINAL HAEMORRHAGE

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Area of Science:

Gastroenterology
Internal Medicine
Clinical Auditing

Background:

Acute upper gastrointestinal bleeding (AUGIB) presents a significant medical emergency.
Management strategies, including medical/endoscopic therapy and transfusion protocols, are continually evolving.
Recent UK audits provide critical data on current AUGIB demographics and treatment approaches.

Purpose of the Study:

To present key findings from the 2022 UK audit of AUGIB.
To compare the 2022 data with the preceding 2007 audit findings.
To identify trends and evaluate changes in AUGIB management and outcomes over time.

Main Methods:

A prospective, multicentre audit involving 147 UK hospitals.
Data collected from adult patients (≥16 years) with AUGIB between May and July 2022.
Patient outcomes tracked until discharge, death, or 28 days, with re-admissions counted as new episodes.

Main Results:

The 2022 cohort (5141 patients) exhibited higher comorbidity (67%), cirrhosis (15%), and anticoagulant use (31%) compared to 2007.
Peptic ulcer disease (32%) and no abnormality (33%) were common causes; 42% lacked pre-endoscopic risk stratification.
Despite increased risk factors, outcomes improved: rebleeding decreased to 9.7%, in-hospital mortality to 8.8%, and median stay to 5 days.
Liberal transfusion (Hb >70 g/L) in stable patients was linked to increased mortality (aOR 1.60 at 80 g/L).

Conclusions:

AUGIB outcomes have improved despite a higher-risk patient profile and suboptimal guideline adherence.
Restrictive transfusion strategies, especially avoiding liberal transfusions above 80 g/L in stable patients, are vital.
Quality improvement initiatives focusing on risk stratification, endoscopic training, and multidisciplinary care are recommended to further improve outcomes.