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Gastroenterology257 papers

Upper gastrointestinal bleeding

Last edited: 4/14/2026

Overview

Upper gastrointestinal bleeding (UGIB) involves hemorrhage originating proximal to the ligament of Treitz, often necessitating hospitalization due to significant morbidity and mortality 116.

Diagnosis

  • Clinical Presentation: Hematemesis, melena, or hematochezia 15.
  • Initial Tests: Hemoglobin levels, coagulation profile, and imaging (e.g., CT angiography) if indicated 15.
  • Endoscopy: Recommended within 24 hours for hemodynamically stable patients to identify the source 11115.
  • Risk Scoring: Use of tools like the Glasgow Blatchford Score (GBS) and Rockall Score for severity assessment 31123.

    • Management

  • Initial Resuscitation: Fluid resuscitation, blood transfusion as needed 15.
  • Endoscopic Intervention: Primary treatment for most cases; endoscopic hemostasis techniques (e.g., clips, epinephrine, thermal coagulation) 11520.
  • Medications:
    • - Proton Pump Inhibitors (PPIs): High-dose PPIs to reduce gastric acid 111. - Antibiotics: Consideration in patients at high risk of infection 111.
  • Surgical Intervention: Reserved for failure of endoscopic management or specific high-risk lesions 1618.

    • Special Populations

  • Elderly: Higher risk of complications; careful assessment and management required 18.
  • Pediatrics: Dexamethasone may reduce postoperative nausea and vomiting with deep sedation 19.
  • Comorbidities: Consider impact on bleeding risk and management strategies 111.

    • Key Recommendations

  • Early Endoscopy: Perform endoscopy within 24 hours for hemodynamically stable patients with suspected UGIB (Evidence: Strong 11115).
  • Risk Assessment: Utilize risk scoring systems (e.g., Glasgow Blatchford Score, Rockall Score) to guide management decisions (Evidence: Moderate 31123).
  • High-Dose PPIs: Administer high-dose proton pump inhibitors to all patients to reduce gastric acid and promote hemostasis (Evidence: Strong 111).
  • Endoscopic Hemostasis: Employ endoscopic techniques for hemostasis in appropriate cases (Evidence: Strong 11520).
  • Monitor BUN Levels: Monitor blood urea nitrogen levels at 24 hours as a predictor of worse outcomes (Evidence: Moderate 22).

    • References

    1 Brand M, Vogt G, Hann A, Weich A, Kudlich T, Lux T et al.. Pilot study on using a photometric capsule to stratify patients with suspected nonvariceal upper gastrointestinal bleeding into emergency versus elective endoscopy. Endoscopy 2026. link 2 Tan SYC, Tsoukalas T, Javier K, Fazon T, Singh S, Vardy J. Recommendations on the surveillance and supplementation of vitamins and minerals for upper gastrointestinal cancer survivors: a scoping review. Journal of cancer survivorship : research and practice 2026. link 3 Wang B, Wang X, Li S, Deng Y, Li Z, Wang Y et al.. Drug-induced upper gastrointestinal bleeding: A real-world pharmacovigilance study. PloS one 2026. link 4 Barkun AN, Laine L, Leontiadis GI, Gralnek IM, Carman N, Ibrahim M et al.. Canadian Association of Gastroenterology Clinical Practice Guideline for the Endoscopic Management of Nonvariceal Nonpeptic Ulcer Upper Gastrointestinal Bleeding. Gastroenterology 2025. link 5 Long B, Gottlieb M. Emergency medicine updates: Upper gastrointestinal bleeding. The American journal of emergency medicine 2024. link 6 Barbaro A, Bunjo Z, Asokan G, Kanhere A, Kuan LL, Trochsler M et al.. Impact of surgical specialization on emergency upper gastrointestinal surgery outcomes: A systematic review and meta-analysis. World journal of surgery 2024. link 7 Yu CJ, Rigueiro F, Backfish-White K, Cartwright J, Moore C, Mitchell SA et al.. Cricothyrotomy in Acute Upper Gastrointestinal Bleed: A Difficult Airway Simulation Case for Anesthesiology Residents. MedEdPORTAL : the journal of teaching and learning resources 2024. link 8 Rajendran L, Hopkins A, Hallet J, Sinha R, Tanwani J, Kao MM et al.. Role of intraoperative processes of care during major upper gastrointestinal oncological resection in postoperative outcomes: a scoping review protocol. BMJ open 2023. link 9 Sønderup MT, Danielsen AK, Rosenberg J. Palliative needs and illness trajectory associated with metastatic upper gastrointestinal cancer. Danish medical journal 2023. link 10 Wu H, Xin L, Lin JH, Wang QH, Li B, Jin ZD et al.. Association between sedation and small neoplasm detection during diagnostic esophagogastroduodenoscopy: a propensity score-matched retrospective study. Scandinavian journal of gastroenterology 2022. link 11 Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. The American journal of gastroenterology 2021. link 12 . Immunotherapy a Likely New Standard for GI Cancers. Cancer discovery 2021. link 13 Zhou J, Li Z, Ji R, Wang P, Zhang A, Wu K et al.. Influence of Sedation on the Detection Rate of Early Cancer and Precancerous Lesions During Diagnostic Upper Gastrointestinal Endoscopies: A Multicenter Retrospective Study. The American journal of gastroenterology 2021. link 14 Marmo R, Soncini M, Marmo C, Borbjerg Laursen S, Gralnek IM, Stanley AJ. Medical care setting is associated with survival in acute upper gastro-intestinal bleeding: A cohort study. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2020. link 15 Mullady DK, Wang AY, Waschke KA. AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review. Gastroenterology 2020. link 16 Kim JS, Kim BW, Kim DH, Park CH, Lee H, Joo MK et al.. Guidelines for Nonvariceal Upper Gastrointestinal Bleeding. Gut and liver 2020. link 17 Thurin NH, Lassalle R, Schuemie M, Pénichon M, Gagne JJ, Rassen JA et al.. Empirical assessment of case-based methods for identification of drugs associated with upper gastrointestinal bleeding in the French National Healthcare System database (SNDS). Pharmacoepidemiology and drug safety 2020. link 18 Miilunpohja S, Kärkkäinen J, Hartikainen J, Jyrkkä J, Rantanen T, Paajanen H. Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009-2015. Digestive surgery 2019. link 19 Moheimani H, Yaseri M. Dexamethasone Reduces Postoperative Nausea in Pediatric Upper Endoscopy With Deep Sedation: A Randomized Controlled Trial. Journal of pediatric gastroenterology and nutrition 2019. link 20 Helsø I, Risom M, Vestergaard TR, Foss NB, Rosenstock S, Møller MH et al.. Anaesthesia in patients undergoing esophago-gastro-duodenoscopy for suspected bleeding. Danish medical journal 2017. link 21 Goudra B, Singh PM. Airway Management During Upper GI Endoscopic Procedures: State of the Art Review. Digestive diseases and sciences 2017. link 22 Kumar NL, Claggett BL, Cohen AJ, Nayor J, Saltzman JR. Association between an increase in blood urea nitrogen at 24 hours and worse outcomes in acute nonvariceal upper GI bleeding. Gastrointestinal endoscopy 2017. link 23 Thanapirom K, Ridtitid W, Rerknimitr R, Thungsuk R, Noophun P, Wongjitrat C et al.. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding. Journal of gastroenterology and hepatology 2016. link 24 Souvignet J, Asfari H, Lardon J, Del Tedesco E, Declerck G, Bousquet C. MedDRA® automated term groupings using OntoADR: evaluation with upper gastrointestinal bleedings. Expert opinion on drug safety 2016. link 25 Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M et al.. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015. link 26 Liang PS, Saltzman JR. A national survey on the initial management of upper gastrointestinal bleeding. Journal of clinical gastroenterology 2014. link 27 Rudzki S, Dryka T, Wilczyński P, Bernat P, Bicki J, Furmaga J et al.. Varices of the descending duodenum explored during emergency gastro-duodenal resection for upper gastrointestinal haemorrhage. Case report. Polski przeglad chirurgiczny 2013. link 28 de Abajo FJ, Gil MJ, Bryant V, Timoner J, Oliva B, García-Rodríguez LA. Upper gastrointestinal bleeding associated with NSAIDs, other drugs and interactions: a nested case-control study in a new general practice database. European journal of clinical pharmacology 2013. link 29 Dinesen L, Benson M. Managing acute upper gastrointestinal bleeding in the acute assessment unit. Clinical medicine (London, England) 2012. link 30 Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. Journal of pediatric gastroenterology and nutrition 2012. link 31 Shah N, Vargo JJ. Basic requirements of gastroenterologists to treat upper gastrointestinal bleeding: competency and sedation issues. Gastrointestinal endoscopy clinics of North America 2011. link 32 Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E et al.. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta gastro-enterologica Belgica 2011. link 33 Weismüller TJ, Schweitzer N, Boozari B, Negm A, Bürger D, Manns MP et al.. Peripapillary duodenal varices as a rare cause of severe bleeding in a patient with no other signs of portal hypertension--successful endoscopic treatment with cyanoacrylate injection. Zeitschrift fur Gastroenterologie 2011. link 34 Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit. Gut 2010. link 35 Shamir R, Eliakim R. Capsule endoscopy in pediatric patients. World journal of gastroenterology 2008. link 36 Esrailian E, Gralnek IM, Jensen D, Laine L, Dulai GS, Eisen G et al.. Evaluating the process of care in nonvariceal upper gastrointestinal haemorrhage: a survey of expert vs. non-expert gastroenterologists. Alimentary pharmacology & therapeutics 2008. link 37 Barriga J, Sachdev MS, Royall L, Brown G, Tombazzi CR. Sedation for upper endoscopy: comparison of midazolam versus fentanyl plus midazolam. Southern medical journal 2008. link 38 Wong M, Karuman P. Vallecular varix causing diagnostic confusion in hematemesis. Head & neck 2008. link 39 Cohen M, Sapoznikov B, Niv Y. Primary and secondary nonvariceal upper gastrointestinal bleeding. Journal of clinical gastroenterology 2007. link 40 Matthes K. Simulator training in endoscopic hemostasis. Gastrointestinal endoscopy clinics of North America 2006. link 41 Klebl F, Bregenzer N, Schöfer L, Tamme W, Langgartner J, Schölmerich J et al.. Risk factors for mortality in severe upper gastrointestinal bleeding. International journal of colorectal disease 2005. link 42 Sanders DS, Perry MJ, Jones SG, McFarlane E, Johnson AG, Gleeson DC et al.. Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation. European journal of gastroenterology & hepatology 2004. link 43 Pardo A, Durández R, Hernández M, Pizarro A, Hombrados M, Jiménez A et al.. Impact of physician specialty on the cost of nonvariceal upper GI bleeding care. The American journal of gastroenterology 2002. link 44 Sandel MH, Kolkman JJ, Kuipers EJ, Cuesta MA, Meuwissen SG. Nonvariceal upper gastrointestinal bleeding: differences in outcome for patients admitted to internal medicine and gastroenterological services. The American journal of gastroenterology 2000. link 45 Wang CY, Ling LC, Cardosa MS, Wong AK, Wong NW. Hypoxia during upper gastrointestinal endoscopy with and without sedation and the effect of pre-oxygenation on oxygen saturation. Anaesthesia 2000. link 46 Quirk DM, Barry MJ, Aserkoff B, Podolsky DK. Physician specialty and variations in the cost of treating patients with acute upper gastrointestinal bleeding. Gastroenterology 1997. link 47 Yen D, Hu SC, Chen LS, Liu K, Kao WF, Tsai J et al.. Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. The American journal of emergency medicine 1997. link90178-9) 48 Scallion R, Wei JP. Upper gastrointestinal hemorrhage from a Mallory-Weiss tear associated with an occult Richter's hernia and small bowel obstruction: to see the forest as well as the trees in the emergency department. The Journal of emergency medicine 1994. link90340-9) 49 Bahal-O'Mara N, Nahata MC, Murray RD, Linscheid TR, Williams T, Heitlinger LA et al.. Efficacy of diazepam and meperidine in ambulatory pediatric patients undergoing endoscopy: a randomized, double-blind trial. Journal of pediatric gastroenterology and nutrition 1993. link 50 Silverman SG, Coughlin BF, Seltzer SE, Swensson RG, Mueller PR. Current use of screening laboratory tests before abdominal interventions: a survey of 603 radiologists. Radiology 1991. link 51 Larson DE, Farnell MB. Upper gastrointestinal hemorrhage. Mayo Clinic proceedings 1983. link

    Original source

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      Pilot study on using a photometric capsule to stratify patients with suspected nonvariceal upper gastrointestinal bleeding into emergency versus elective endoscopy. — Brand M, Vogt G, Hann A, Weich A, Kudlich T, Lux T et al. Endoscopy (2026)
    2. [2]
      Recommendations on the surveillance and supplementation of vitamins and minerals for upper gastrointestinal cancer survivors: a scoping review. — Tan SYC, Tsoukalas T, Javier K, Fazon T, Singh S, Vardy J Journal of cancer survivorship : research and practice (2026)
    3. [3]
      Drug-induced upper gastrointestinal bleeding: A real-world pharmacovigilance study. — Wang B, Wang X, Li S, Deng Y, Li Z, Wang Y et al. PloS one (2026)
    4. [4]
      Canadian Association of Gastroenterology Clinical Practice Guideline for the Endoscopic Management of Nonvariceal Nonpeptic Ulcer Upper Gastrointestinal Bleeding. — Barkun AN, Laine L, Leontiadis GI, Gralnek IM, Carman N, Ibrahim M et al. Gastroenterology (2025)
    5. [5]
      Emergency medicine updates: Upper gastrointestinal bleeding. — Long B, Gottlieb M The American journal of emergency medicine (2024)
    6. [6]
      Impact of surgical specialization on emergency upper gastrointestinal surgery outcomes: A systematic review and meta-analysis. — Barbaro A, Bunjo Z, Asokan G, Kanhere A, Kuan LL, Trochsler M et al. World journal of surgery (2024)
    7. [7]
      Cricothyrotomy in Acute Upper Gastrointestinal Bleed: A Difficult Airway Simulation Case for Anesthesiology Residents. — Yu CJ, Rigueiro F, Backfish-White K, Cartwright J, Moore C, Mitchell SA et al. MedEdPORTAL : the journal of teaching and learning resources (2024)
    8. [8]
      Role of intraoperative processes of care during major upper gastrointestinal oncological resection in postoperative outcomes: a scoping review protocol. — Rajendran L, Hopkins A, Hallet J, Sinha R, Tanwani J, Kao MM et al. BMJ open (2023)
    9. [9]
      Palliative needs and illness trajectory associated with metastatic upper gastrointestinal cancer. — Sønderup MT, Danielsen AK, Rosenberg J Danish medical journal (2023)
    10. [10]
      Association between sedation and small neoplasm detection during diagnostic esophagogastroduodenoscopy: a propensity score-matched retrospective study. — Wu H, Xin L, Lin JH, Wang QH, Li B, Jin ZD et al. Scandinavian journal of gastroenterology (2022)
    11. [11]
      ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. — Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI The American journal of gastroenterology (2021)
    12. [12]
      Immunotherapy a Likely New Standard for GI Cancers. Cancer discovery (2021)
    13. [13]
      Influence of Sedation on the Detection Rate of Early Cancer and Precancerous Lesions During Diagnostic Upper Gastrointestinal Endoscopies: A Multicenter Retrospective Study. — Zhou J, Li Z, Ji R, Wang P, Zhang A, Wu K et al. The American journal of gastroenterology (2021)
    14. [14]
      Medical care setting is associated with survival in acute upper gastro-intestinal bleeding: A cohort study. — Marmo R, Soncini M, Marmo C, Borbjerg Laursen S, Gralnek IM, Stanley AJ Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2020)
    15. [15]
      AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review. — Mullady DK, Wang AY, Waschke KA Gastroenterology (2020)
    16. [16]
      Guidelines for Nonvariceal Upper Gastrointestinal Bleeding. — Kim JS, Kim BW, Kim DH, Park CH, Lee H, Joo MK et al. Gut and liver (2020)
    17. [17]
      Empirical assessment of case-based methods for identification of drugs associated with upper gastrointestinal bleeding in the French National Healthcare System database (SNDS). — Thurin NH, Lassalle R, Schuemie M, Pénichon M, Gagne JJ, Rassen JA et al. Pharmacoepidemiology and drug safety (2020)
    18. [18]
      Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009-2015. — Miilunpohja S, Kärkkäinen J, Hartikainen J, Jyrkkä J, Rantanen T, Paajanen H Digestive surgery (2019)
    19. [19]
      Dexamethasone Reduces Postoperative Nausea in Pediatric Upper Endoscopy With Deep Sedation: A Randomized Controlled Trial. — Moheimani H, Yaseri M Journal of pediatric gastroenterology and nutrition (2019)
    20. [20]
      Anaesthesia in patients undergoing esophago-gastro-duodenoscopy for suspected bleeding. — Helsø I, Risom M, Vestergaard TR, Foss NB, Rosenstock S, Møller MH et al. Danish medical journal (2017)
    21. [21]
      Airway Management During Upper GI Endoscopic Procedures: State of the Art Review. — Goudra B, Singh PM Digestive diseases and sciences (2017)
    22. [22]
      Association between an increase in blood urea nitrogen at 24 hours and worse outcomes in acute nonvariceal upper GI bleeding. — Kumar NL, Claggett BL, Cohen AJ, Nayor J, Saltzman JR Gastrointestinal endoscopy (2017)
    23. [23]
      Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding. — Thanapirom K, Ridtitid W, Rerknimitr R, Thungsuk R, Noophun P, Wongjitrat C et al. Journal of gastroenterology and hepatology (2016)
    24. [24]
      MedDRA® automated term groupings using OntoADR: evaluation with upper gastrointestinal bleedings. — Souvignet J, Asfari H, Lardon J, Del Tedesco E, Declerck G, Bousquet C Expert opinion on drug safety (2016)
    25. [25]
      Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. — Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M et al. Endoscopy (2015)
    26. [26]
      A national survey on the initial management of upper gastrointestinal bleeding. — Liang PS, Saltzman JR Journal of clinical gastroenterology (2014)
    27. [27]
      Varices of the descending duodenum explored during emergency gastro-duodenal resection for upper gastrointestinal haemorrhage. Case report. — Rudzki S, Dryka T, Wilczyński P, Bernat P, Bicki J, Furmaga J et al. Polski przeglad chirurgiczny (2013)
    28. [28]
      Upper gastrointestinal bleeding associated with NSAIDs, other drugs and interactions: a nested case-control study in a new general practice database. — de Abajo FJ, Gil MJ, Bryant V, Timoner J, Oliva B, García-Rodríguez LA European journal of clinical pharmacology (2013)
    29. [29]
      Managing acute upper gastrointestinal bleeding in the acute assessment unit. — Dinesen L, Benson M Clinical medicine (London, England) (2012)
    30. [30]
      Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. — Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F Journal of pediatric gastroenterology and nutrition (2012)
    31. [31]
      Basic requirements of gastroenterologists to treat upper gastrointestinal bleeding: competency and sedation issues. — Shah N, Vargo JJ Gastrointestinal endoscopy clinics of North America (2011)
    32. [32]
      Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. — Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E et al. Acta gastro-enterologica Belgica (2011)
    33. [33]
      Peripapillary duodenal varices as a rare cause of severe bleeding in a patient with no other signs of portal hypertension--successful endoscopic treatment with cyanoacrylate injection. — Weismüller TJ, Schweitzer N, Boozari B, Negm A, Bürger D, Manns MP et al. Zeitschrift fur Gastroenterologie (2011)
    34. [34]
      Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit. — Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR Gut (2010)
    35. [35]
      Capsule endoscopy in pediatric patients. — Shamir R, Eliakim R World journal of gastroenterology (2008)
    36. [36]
      Evaluating the process of care in nonvariceal upper gastrointestinal haemorrhage: a survey of expert vs. non-expert gastroenterologists. — Esrailian E, Gralnek IM, Jensen D, Laine L, Dulai GS, Eisen G et al. Alimentary pharmacology & therapeutics (2008)
    37. [37]
      Sedation for upper endoscopy: comparison of midazolam versus fentanyl plus midazolam. — Barriga J, Sachdev MS, Royall L, Brown G, Tombazzi CR Southern medical journal (2008)
    38. [38]
      Vallecular varix causing diagnostic confusion in hematemesis. — Wong M, Karuman P Head & neck (2008)
    39. [39]
      Primary and secondary nonvariceal upper gastrointestinal bleeding. — Cohen M, Sapoznikov B, Niv Y Journal of clinical gastroenterology (2007)
    40. [40]
      Simulator training in endoscopic hemostasis. — Matthes K Gastrointestinal endoscopy clinics of North America (2006)
    41. [41]
      Risk factors for mortality in severe upper gastrointestinal bleeding. — Klebl F, Bregenzer N, Schöfer L, Tamme W, Langgartner J, Schölmerich J et al. International journal of colorectal disease (2005)
    42. [42]
      Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation. — Sanders DS, Perry MJ, Jones SG, McFarlane E, Johnson AG, Gleeson DC et al. European journal of gastroenterology & hepatology (2004)
    43. [43]
      Impact of physician specialty on the cost of nonvariceal upper GI bleeding care. — Pardo A, Durández R, Hernández M, Pizarro A, Hombrados M, Jiménez A et al. The American journal of gastroenterology (2002)
    44. [44]
      Nonvariceal upper gastrointestinal bleeding: differences in outcome for patients admitted to internal medicine and gastroenterological services. — Sandel MH, Kolkman JJ, Kuipers EJ, Cuesta MA, Meuwissen SG The American journal of gastroenterology (2000)
    45. [45]
      Hypoxia during upper gastrointestinal endoscopy with and without sedation and the effect of pre-oxygenation on oxygen saturation. — Wang CY, Ling LC, Cardosa MS, Wong AK, Wong NW Anaesthesia (2000)
    46. [46]
      Physician specialty and variations in the cost of treating patients with acute upper gastrointestinal bleeding. — Quirk DM, Barry MJ, Aserkoff B, Podolsky DK Gastroenterology (1997)
    47. [47]
      Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. — Yen D, Hu SC, Chen LS, Liu K, Kao WF, Tsai J et al. The American journal of emergency medicine (1997)
    48. [48]
      Upper gastrointestinal hemorrhage from a Mallory-Weiss tear associated with an occult Richter's hernia and small bowel obstruction: to see the forest as well as the trees in the emergency department. — Scallion R, Wei JP The Journal of emergency medicine (1994)
    49. [49]
      Efficacy of diazepam and meperidine in ambulatory pediatric patients undergoing endoscopy: a randomized, double-blind trial. — Bahal-O'Mara N, Nahata MC, Murray RD, Linscheid TR, Williams T, Heitlinger LA et al. Journal of pediatric gastroenterology and nutrition (1993)
    50. [50]
      Current use of screening laboratory tests before abdominal interventions: a survey of 603 radiologists. — Silverman SG, Coughlin BF, Seltzer SE, Swensson RG, Mueller PR Radiology (1991)
    51. [51]
      Upper gastrointestinal hemorrhage. — Larson DE, Farnell MB Mayo Clinic proceedings (1983)
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