Editorial Open Access
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2024; 12(24): 5462-5467
Published online Aug 26, 2024. doi: 10.12998/wjcc.v12.i24.5462
Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding
Rick Maity, General Medicine, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
Arkadeep Dhali, Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, United Kingdom
Arkadeep Dhali, School of Medicine and Population Health, University of Sheffield, Sheffield S102HQ, United Kingdom
Jyotirmoy Biswas, General Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India
ORCID number: Rick Maity (0009-0003-5316-2329); Arkadeep Dhali (0000-0002-1794-2569); Jyotirmoy Biswas (0000-0001-9357-0448).
Author contributions: Maity R conducted literature review and wrote the primary manuscript; Dhali A conceptualized the article; Biswas J conducted literature review and wrote the primary manuscript. All authors agreed with the final version of the manuscript.
Conflict-of-interest statement: No conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arkadeep Dhali, MBBS, MPH, PGCert Clin Ed, FRSPH, NIHR Academic Clinical Fellow, Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, United Kingdom. arkadipdhali@gmail.com
Received: March 10, 2024
Revised: April 20, 2024
Accepted: May 17, 2024
Published online: August 26, 2024
Processing time: 122 Days and 11.5 Hours


Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common medical emergency in clinical practice. While the incidence has significantly reduced, the mortality rates have not undergone a similar reduction in the last few decades, thus presenting a significant challenge. This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis. Since ANUVGIB predominantly affects the elderly population, the impact of comorbidities may be responsible for the poor outcomes. A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly. Early risk stratification plays a crucial role in deciding the line of management and predicting mortality. Emerging scoring systems such as the ABC (age, blood tests, co-morbidities) score show promise in predicting mortality and guiding clinical decisions. While conventional endoscopic therapies remain cornerstone approaches, novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives, particularly in cases refractory to traditional modalities. By integrating validated scoring systems and leveraging novel therapeutic modalities, clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.

Key Words: Non-variceal upper gastrointestinal bleeding, Upper gastrointestinal bleeding, Gastrointestinal bleeding, Risk stratification, Risk assessment scores, Prognostication, Endoscopy, Esophagogastroduodenoscopy, Endoscopic hemostasis

Core Tip: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) presents a significant medical challenge. Despite advancements in management, mortality remains high in the context of an increasingly elderly, comorbid population. While early risk stratification using established scoring systems ensures targeted management, newer scoring systems show promise in predicting mortality and should be integrated into medical practice after proper validation. Novel endoscopic techniques offer promising alternatives, especially in cases where conventional modalities are ineffective. By integrating validated scoring systems and adopting innovative therapeutic modalities, clinicians can enhance patient care and mitigate the substantial mortality associated with ANVUGIB.


Acute upper gastrointestinal bleeding (UGIB), defined as any bleeding originating above the ligament of Treitz in the duodenum, is a medical emergency commonly encountered in clinical practice[1,2]. According to their etiology, upper gastrointestinal hemorrhage is further subdivided into variceal and non-variceal UGIB (NVUGIB). Acute non-variceal UGIB (ANVUGIB) has an annual incidence of 67 per 100000 individuals and accounts for 80% of all cases of UGIB[3,4]. In the recent issue of the World Journal of Clinical Cases, we read with interest an article that elucidated the clinical characteristics of ANVUGIB by retrospectively analyzing patient data from a tertiary-care hospital in China[5]. The high mortality rates and the effectiveness of endoscopic hemostasis in the management of ANVUGIB particularly piqued our interest. Despite the advances in diagnostic and treatment modalities, NVUGIB remains a common medical problem owing to its sudden onset and rapid progression, prevalence of risk factors such as cardiovascular disease, increasing use of blood-thinning medications (such as aspirin, anticoagulants, and antiplatelet agents) and non-steroidal anti-inflammatory drugs (NSAIDs), and high morbidity and mortality[6,7]. The current guidelines recommend esophagogastroduodenoscopy (EGD) as the procedure of choice for both the diagnosis and management of NVUGIB and transcatheter angiographic embolization or surgery in cases of refractory bleeding[8-11]. Various risk assessment scores, such as the Glasgow-Blatchford Score (GBS) and the Rockall score, are routinely used for risk stratification in UGIB and may have a role in predicting the risk of mortality due to re-bleeding[12]. Thus, risk stratification and endoscopic interventions are key tools in deciding the line of management and determining morbidity and mortality. This editorial reviews the current demographics, etiologies, and risk factors associated with ANVUGIB and highlights the crucial role of early risk stratification in reducing mortality and endoscopic therapies in achieving hemostasis. It also discusses the emerging scoring systems and novel endoscopic technologies that show promise in guiding clinical decisions and reducing mortality.


Males are affected more compared to females, with the majority of patients being older than 65 years[13,14]. Peptic ulcer disease (PUD) is the most common cause of ANVUGIB, followed by upper gastrointestinal malignancy, Mallory-Weiss syndrome, and gastric angiodysplasia[4,13].

Significant advancements in medicine have caused a reduction in ulcer-related bleeding over time due to the decreased incidence of PUD itself[13]. However, the mortality rates have not changed much, owing to the impact of co-morbidities in an aging population[2]. Cardiovascular disease (congestive heart failure, ischemic heart disease) is the most frequent comorbidity encountered in such patients, followed by diabetes mellitus, chronic liver disease, and chronic kidney disease[13,14].

Besides co-morbidities, there are other factors that increase the chances of mortality from NVUGIB. Particular attention must be paid to the patient's drug history. NSAIDs and aspirin (acetyl-salicylic acid) are recognized risk factors for increasing the chance of bleeding from peptic ulcers and severe erosive gastritis[15]. These drugs can cause NVUGIB by reducing prostaglandins in the gastric mucosa and increasing the susceptibility to mucosal damage[16,17]. The use of anticoagulants and antiplatelet drugs in an aging population with multiple co-morbidities may be associated with an increased risk of bleeding in NVUGIB[17,18]. Helicobacter pylori (H. pylori) infection represents the single most common cause of PUD, which is in turn the leading cause of NVUGIB[19]. H. pylori status should be assessed in cases of NVUGIB due to PUD and reassessed after four weeks if the results are negative[10]. Yin and Yu[17] described a risk prediction model and concluded six independent risk factors for NVUGIB by analyzing two years' worth of clinical data retrospectively[17]. The risk factors for NVUGIB are summarized in Table 1.

Table 1 Risk factors for non-variceal upper gastrointestinal bleeding.
Risk factors
Value of parameter
History of peptic ulcer
Helicobacter pylori infection
Use of anticoagulant and antiplatelet drugs
Prolonged INRINR ≥ 1.21
Increase in leukocyte count
HypoalbuminemiaSerum albumin level < 35 g/L

Following successful initial resuscitation, patients should be stratified as low- and high-risk using risk assessment scoring systems to ensure appropriate patient disposition. These scoring systems act as clinical prediction guides and can be used to predict the line of treatment and mortality[20]. Getting timely endoscopic hemostatic treatment is crucial for improving the chances of survival, especially in high-risk groups. Proper evaluation of the patient's hemodynamic status and accurate risk assessment can lead to successful treatments. This is why a highly efficient scoring system is needed to help predict the prognosis and guide appropriate management[21]. There are a variety of scoring systems, each with different goals, like assessing the type of intervention, mortality, length of hospital stay, need for blood transfusions, etc. Some utilize only clinical data (pre-endoscopy scoring systems), while others require additional endoscopic findings (post-endoscopy scoring systems)[22]. A compilation of scoring systems is provided in Table 2.

Table 2 List of risk assessment scores for non-variceal upper gastrointestinal bleeding.
Type of risk assessment score
Pre-endoscopy risk scoreABC score
AIMS65 score
CANUKA score
Glasgow-Blatchford Score
MAP (ASH) score
Pre-endoscopic Rockall score
Post-endoscopy risk scoreComplete Rockall score
CSMCPI score
PNED score

Some well-established pre-endoscopy scoring systems are the Glasgow-Blatchford Score (GBS), pre-endoscopic Rockall Score, and AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age ≥ 65 years) score[23-25]. Initially developed to predict the need for intervention, the GBS has been found to possess the highest accuracy in predicting the need for hospital-based intervention and mortality[26]. As such, guidelines recommend the use of GBS for risk stratification in UGIB and state that patients with GBS ≤ 1 have a low risk of mortality and can be managed as an outpatient[10,11,27].

The age, blood tests, co-morbidities (ABC) score and international bleeding score (INBS) are newly-developed pre-endoscopy scoring systems that can accurately predict the 30-day mortality in patients with NVUGIB[21,28]. The ABC score appeals as a clinical tool in terms of simplicity and ease of assessment at the bedside and has outperformed the traditional prognostic scores (which include scores like the GBS) in predicting mortality in patients with UGIB[29]. Studies have shown that the ABC score works better on younger patients compared to older patients[29]. The INBS is a novel prognostic score that is computed using medical history and biochemical results. It has been found to be superior to the traditional scoring systems in predicting mortality and can estimate the chances of re-bleeding, endoscopic hemostasis failure, and the duration of hospitalization[21]. These scoring systems need validation from large-scale studies before they can be incorporated into clinical practice.

Since post-endoscopy scores require endoscopy findings, it may delay risk assessment in setups where endoscopy is the limiting factor in UGIB management. Early risk stratification allows for early identification of high-risk patients, thereby ensuring targeted management of low- and high-risk patients[11,27]. Therefore, much of the focus should be on pre-endoscopy scoring systems, which can be calculated soon after patient presentation. Pre-endoscopy scores like the ABC score and INBS can be useful as quick and effective tools in predicting the outcomes of ANVUGIB, shortening hospital stays, and guiding clinical decisions to reduce mortality by increasing the chances of successful endoscopic hemostasis.


After initial resuscitation and hemodynamic stabilization, patients with UGIB should undergo endoscopy within 24 h of admission. Endoscopy is the procedure of choice for the diagnosis and management of ANVUGIB[8-11]. Current guidelines recommend early endoscopy (within 24 h) in both high- and low-risk patients since early endoscopies result in early discharges, reduced length of hospital stay, and improved outcomes[2]. However, the optimal timing of endoscopy in high-risk patients remains controversial. While some studies found no significant difference in mortality rates between urgent and early endoscopies, other studies reported a reduction in hospital stay and mortality after urgent endoscopies in patients with ANVUGIB[30,31]. The advancement of endoscopic therapy has brought down the hospitalization rate and mortality of UGIB over the last decade[32]. Therapeutic upper gastrointestinal endoscopy via EGD has been effective in achieving hemostasis[9,15]. Traditionally, endoscopic therapies achieving hemostasis have been classified into three categories: Injection therapy (involving injection of epinephrine, sclerosant, and thrombin), thermal therapy (with contact or non-contact probes causing electrocoagulation), and mechanical therapy (with clips, loops, and ligation)[15]. These modalities form the mainstay of standard endoscopic management. However, the advancement of newer endoscopic devices has the potential to improve outcomes in cases where conventional therapies fail to achieve hemostasis[15]. Several new hemostatic techniques have emerged over the past decade[15], which have been summarized in Table 3. These novel techniques have diverse approaches, ranging from upgrading current techniques to creating new technologies. Some of them have been incorporated into the current guidelines and are recommended as rescue or salvage therapies, while others should be considered when conventional interventions have failed[9]. For instance, hemostatic powders (non-absorbable mineral powders) can achieve immediate hemostasis by forming an adhesive mechanical barrier on contact with water and may be considered in ANVUGIB due to malignancy[9,20,27]. Current guidelines recommend over-the-scope clips (large-caliber clips that allow full circumferential tissue closure of large lesions) in select NVUGIB cases (especially cases of recurrent and persistent bleeding) where standard endoscopic modalities fail to stop the bleeding[9,20,27]. Over-the-scope clipping systems are fast gaining prominence as possible first-line endoscopic treatments since they are shown to outperform standard endoscopic modalities in reducing the bleeding risk and mortality in high-risk cases of NVUGIB[15,20]. These advancements have the potential to plug the loopholes of conventional therapies, but they are not without their fair share of limitations[15,20]. Further large-scale studies are needed to identify their indications and validate their effects on morbidity and mortality before they can be fully incorporated into clinical practice.

Table 3 Summary of emerging endoscopic modalities for the management of non-variceal upper gastrointestinal bleeding.
Modality type
Endoscopic modalities
Mechanism of action
InjectionEndoscopic ultrasound-guided angiotherapyControls variceal bleeding by deploying coils and injecting cyanoacrylate glue directly into targeted vessels, and confirming the thrombosis in real time with Doppler
ThermalCoagulation grasper (Coagrasper)A combination mechanical and thermal hemostasis device that delivers targeted monopolar coagulation at the precise site of bleeding
Radiofrequency ablationHigh-frequency alternating electrical current delivered to local tissue via radiofrequency electrode, causing thermal coagulative necrosis of the targeted tissue
Cryotherapy Induces cell necrosis through cycles of controlled local freezing and thawing of the tissue
Endoscopic laser coagulationInstantaneous hemostatic effect due to alterations in structural proteins in the vessel wall causing vessel shrinkage
TopicalHemospray (TC-325 hemostatic powder)Non-absorbable mineral powder that forms an adhesive mechanical barrier upon contact with water
EndoClot (polysaccharide hemostatic powder)Absorbable modified plant-based polymer that forms a protective gel matrix and concentrates coagulation factors upon contact with water
Oxidized regenerated celluloseAbsorbable plant-based polymer that provides a matrix for clot formation and enhances platelet activation and adhesion
Ankaferd Blood Stopper Standardized mixture of plant extracts that induces formation of an encapsulated protein network which provides focal points for vital erythrocyte aggregation
MechanicalOver-the-scope clip systemLarge caliber clips made of metal alloy nitinol with shape-memory effect that stops bleeding by exerting constant circumferential compression force on the bleeding site
Endoscopic suturing deviceExcludes peptic ulcer from the intra-gastric acidic environment to prevent rebleeding
Endoscopic band ligationComplete obliteration of varices by causing mechanical strangulation with rubber bands

ANVUGIB is a common medical emergency that has a high mortality rate despite its declining incidence. As the majority of patients are elderly, the increasing burden of comorbidities and the prevalence of risk factors in the geriatric population increase the likelihood of poor outcomes in high-risk groups. The increasing use of drugs such as NSAIDs, antiplatelet agents, and anticoagulants (especially in the elderly population) underscores the significance of obtaining a thorough drug history. Early risk stratification with validated scoring systems is the key to determining the line of management. Newly developed scores (like the ABC score and INBS), which are superior to the traditional scores in predicting outcomes, should be incorporated into clinical guidelines after obtaining good-quality evidence. Upper gastrointestinal endoscopies have both diagnostic and therapeutic applications and should be performed within 24 h of patient admission. Novel advancements in endoscopic therapies like hemostatic powder and over-the-scope clips have the potential to become first-line treatments in cases where standard endoscopic therapies are ineffective. Clinicians should be aware of the recent advances in risk stratification and endoscopic interventions in order to make informed decisions about targeted management for low- and high-risk patients. By integrating validated scoring systems and leveraging cutting-edge therapeutic modalities, clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with this critical condition.


Provenance and peer review: Invited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Medicine, research and experimental

Country of origin: United Kingdom

Peer-review report’s classification

Scientific Quality: Grade B

Novelty: Grade B

Creativity or Innovation: Grade B

Scientific Significance: Grade B

P-Reviewer: Dimofte GM S-Editor: Liu H L-Editor: A P-Editor: Xu ZH

1.  Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60:1327-1335.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 398]  [Cited by in F6Publishing: 401]  [Article Influence: 30.8]  [Reference Citation Analysis (0)]
2.  Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther. 2015;6:172-182.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 1.4]  [Reference Citation Analysis (1)]
3.  Almadi MA, Almutairdi A, Alruzug IM, Aldarsouny TA, Semaan T, Aldaher MK, AlMustafa A, Azzam N, Batwa F, Albawardy B, Aljebreen A. Upper gastrointestinal bleeding: Causes and patient outcomes. Saudi J Gastroenterol. 2021;27:20-27.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 2]  [Reference Citation Analysis (0)]
4.  Lanas A, Dumonceau JM, Hunt RH, Fujishiro M, Scheiman JM, Gralnek IM, Campbell HE, Rostom A, Villanueva C, Sung JJY. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers. 2018;4:18020.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 56]  [Cited by in F6Publishing: 68]  [Article Influence: 11.3]  [Reference Citation Analysis (0)]
5.  Wang XJ, Shi YP, Wang L, Li YN, Xu LJ, Zhang Y, Han S. Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis. World J Clin Cases. 2024;12:1597-1605.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
6.  Lau JY, Barkun A, Fan DM, Kuipers EJ, Yang YS, Chan FK. Challenges in the management of acute peptic ulcer bleeding. Lancet. 2013;381:2033-2043.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 142]  [Cited by in F6Publishing: 139]  [Article Influence: 12.6]  [Reference Citation Analysis (0)]
7.  Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107:345-60; quiz 361.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 483]  [Cited by in F6Publishing: 449]  [Article Influence: 37.4]  [Reference Citation Analysis (1)]
8.  Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116:899-917.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 66]  [Cited by in F6Publishing: 173]  [Article Influence: 57.7]  [Reference Citation Analysis (0)]
9.  Mullady DK, Wang AY, Waschke KA. AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review. Gastroenterology. 2020;159:1120-1128.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 60]  [Article Influence: 15.0]  [Reference Citation Analysis (0)]
10.  Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, Laursen SB, Radaelli F, Papanikolaou IS, Cúrdia Gonçalves T, Dinis-Ribeiro M, Awadie H, Braun G, de Groot N, Udd M, Sanchez-Yague A, Neeman Z, van Hooft JE. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53:300-332.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 93]  [Cited by in F6Publishing: 175]  [Article Influence: 58.3]  [Reference Citation Analysis (1)]
11.  Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171:805-822.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 209]  [Cited by in F6Publishing: 270]  [Article Influence: 54.0]  [Reference Citation Analysis (0)]
12.  Custovic N, Husic-Selimovic A, Srsen N, Prohic D. Comparison of Glasgow-Blatchford Score and Rockall Score in Patients with Upper Gastrointestinal Bleeding. Med Arch. 2020;74:270-274.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 4]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
13.  Falcão D, Alves da Silva J, Pereira Guedes T, Garrido M, Novo I, Pedroto I. The Current Portrayal of Non-Variceal Upper Gastrointestinal Bleeding in a Portuguese Tertiary Center. GE Port J Gastroenterol. 2021;28:392-397.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
14.  Asotibe JC, Shaka H, Akuna E, Shekar N, Shah H, Ramirez M, Sherazi SAA, Khoshbin K, Mutneja H, Attar B. Outcomes of Non-Variceal Upper Gastrointestinal Bleed Stratified by Hospital Teaching Status: Insights From the National Inpatient Sample. Gastroenterology Res. 2021;14:268-274.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
15.  Naseer M, Lambert K, Hamed A, Ali E. Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding: A review. World J Gastrointest Endosc. 2020;12:1-16.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 17]  [Cited by in F6Publishing: 14]  [Article Influence: 3.5]  [Reference Citation Analysis (0)]
16.  Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr. 2017;40:91-93.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 98]  [Article Influence: 14.0]  [Reference Citation Analysis (0)]
17.  Yin L, Yu W. Retrospective analysis of risk factors for non-variceal upper gastrointestinal bleeding and construction of a nomogram prediction model. Am J Transl Res. 2023;15:3385-3393.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Tham TC, James C, Kelly M. Predicting outcome of acute non-variceal upper gastrointestinal haemorrhage without endoscopy using the clinical Rockall Score. Postgrad Med J. 2006;82:757-759.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 38]  [Cited by in F6Publishing: 31]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
19.  Saleem N, Howden CW. Update on the Management of Helicobacter pylori Infection. Curr Treat Options Gastroenterol. 2020;18:476-487.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 31]  [Article Influence: 7.8]  [Reference Citation Analysis (0)]
20.  Lau LHS, Sung JJY. Treatment of upper gastrointestinal bleeding in 2020: New techniques and outcomes. Dig Endosc. 2021;33:83-94.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 21]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
21.  Kim MS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Sung JK, Lee ES, Kim SH, Lee BS, Jeong HY. Validation of a new risk score system for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol. 2020;20:193.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
22.  Orpen-Palmer J, Stanley AJ. A Review of Risk Scores within Upper Gastrointestinal Bleeding. J Clin Med. 2023;12.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
23.  Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356:1318-1321.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 666]  [Cited by in F6Publishing: 628]  [Article Influence: 26.2]  [Reference Citation Analysis (0)]
24.  Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316-321.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 888]  [Cited by in F6Publishing: 853]  [Article Influence: 30.5]  [Reference Citation Analysis (0)]
25.  Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74:1215-1224.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 286]  [Cited by in F6Publishing: 304]  [Article Influence: 23.4]  [Reference Citation Analysis (0)]
26.  Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, Zakko L, Thornton S, Wilkinson K, Khor CJ, Murray IA, Laursen SB; International Gastrointestinal Bleeding Consortium. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 181]  [Cited by in F6Publishing: 187]  [Article Influence: 26.7]  [Reference Citation Analysis (0)]
27.  Sung JJ, Chiu PW, Chan FKL, Lau JY, Goh KL, Ho LH, Jung HY, Sollano JD, Gotoda T, Reddy N, Singh R, Sugano K, Wu KC, Wu CY, Bjorkman DJ, Jensen DM, Kuipers EJ, Lanas A. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018;67:1757-1768.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 129]  [Cited by in F6Publishing: 158]  [Article Influence: 26.3]  [Reference Citation Analysis (0)]
28.  Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, Dalton HR, Ngu J, Schultz M, Soncini M, Gralnek I, Jairath V, Murray IA, Stanley AJ. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut. 2021;70:707-716.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 62]  [Article Influence: 20.7]  [Reference Citation Analysis (0)]
29.  Li Y, Lu Q, Song M, Wu K, Ou X. Comparisons of six endoscopy independent scoring systems for the prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal bleeding. BMC Gastroenterol. 2022;22:187.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
30.  Güven İE, Başpınar B, Durak MB, Yüksel İ. Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients. Gastroenterol Hepatol. 2023;46:178-184.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
31.  Kim J, Gong EJ, Seo M, Park JK, Lee SJ, Han KH, Kim YD, Jeong WJ, Cheon GJ, Seo HI. Timing of endoscopy in patients with upper gastrointestinal bleeding. Sci Rep. 2022;12:6833.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 2]  [Reference Citation Analysis (0)]
32.  Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci. 2018;63:1286-1293.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 108]  [Cited by in F6Publishing: 135]  [Article Influence: 22.5]  [Reference Citation Analysis (0)]