Mandatory medical device diagnostics.
- Esophagogastroduodenoscopy (OGD) (endoscopy of the esophagus (gullet), stomach (gastro), and upper part of the duodenum (duodenum)) with biopsies (specimen collection) from all suspicious lesions; in Barrett’s esophagus, additional 4-quadrant biopsies – if upper gastrointestinal bleeding is suspected; in acute bleeding, also for therapy
- Rectoscopy and colonoscopy (rectal and colonoscopy) – if lower gastrointestinal bleeding is suspected.
- Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnosticsNote: In an unstable patient with rectal fresh blood, an upper source of bleeding is sought first!
- Contrast-enhanced multislice computed tomography (CT); where at least one arterial phase should be acquired after intravenous contrast administration – patients with suspected active gastrointestinal bleeding without identification of the bleeding source by endoscopic diagnostics
Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification.
- Video capsule endoscopy (procedure to visualize the mucosa of the digestive tract (esp. the small intestine) using a swallowable camera capsule) – in the case of unremarkable gastro- and colonoscopyNote: Capsule endoscopy should not be performed in the case of known high-grade stenosis (narrowing) of the gastrointestinal tract.
- Selective arteriography * – Imaging of the arteries in the presence of bleeding for precise localization.
- Nuclear medicine procedures such as Tc-RBC scintigraphy * – for precise localization of the source of bleeding.
* Reserve procedure for localization diagnosis of occult gastrointestinal bleeding; should be limited to individual cases.
Glasgow-Blatchford score (GBS) for nonvariceal upper gastrointestinal bleeding.
| Criterion | Expression | Score |
| Heart rate | ≥ 100/min. | 1 |
| Systolic blood pressure | 100-190 mmHg | 1 |
| 90-99 mmHg | 2 | |
| < 90 mmHg | 3 | |
| Urea (mg/dl) | ≥ 18.2 and < 22.4 mg/dl | 2 |
| ≥ 22.4 and < 28 mg/dl | 3 | |
| ≥ 28 and < 70 mg/dl | 4 | |
| ≥ 70 mg/dl | 6 | |
| Hemoglobin (man) | ≥ 12 and < 13 g/dl | 1 |
| ≥ 10 and < 12 g/dl | 3 | |
| <10 g/dL | 6 | |
| Hemoglobin (female) | ≥ 10 and < 12 g/dl | 3 |
| <10 g/dL | 6 |
This score can predict the necessities of endoscopic intervention with high sensitivity and specificity.
Annotation:
- Urea originally reported as blood urea nitrogen (BUN).
- Urea: conversion from mmol/l to mg/dl:
- Urea in mmol/l / 0.1665 = urea in mg/dl
- Conversion of urea to BUN:
- Urea in mg/dl / 2.142 = BUN in mg/dl.
Rating:
- Low-risk group: 0-1 point
- Maximum score: 16 points.
