Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
In a primary care setting, the key investigations to determine the cause of upper gastrointestinal bleeding include:
- Clinical assessment and risk stratification: Use formal risk assessment tools such as the Blatchford score at first assessment to evaluate the severity and need for urgent referral or intervention NICE CG141.
- Full blood count (FBC): To assess for anaemia and platelet count, which can indicate bleeding severity and guide further management NICE CG141,NICE NG12.
- Coagulation profile: Including prothrombin time and international normalised ratio (INR), especially if the patient is on anticoagulants, to assess bleeding risk and guide reversal if necessary NICE CG141.
- Referral for upper gastrointestinal endoscopy: This is the definitive investigation to identify the source of bleeding and should be arranged urgently or non-urgently depending on clinical stability and risk factors. In primary care, patients with haematemesis or other high-risk features should be referred for direct access endoscopy NICE CG141,NICE NG12.
- Additional tests: In some cases, consider testing for Helicobacter pylori infection if peptic ulcer disease is suspected, although this is usually done after specialist referral NICE CG141.
Primary care's role is mainly initial assessment, risk stratification, and urgent referral for endoscopy rather than performing invasive investigations directly NICE CG141,NICE NG12.