The latest in the series of ‘Controversies in…’ Twitter debates for Frontline Gastroenterology was led by AJS (@AdrianStanleyGI) in a discussion on the topic of acute upper gastrointestinal bleeding (UGIB). This remains a medical emergency that is frequently encountered by both general physicians and gastroenterologists, with in-hospital mortality of approximately 10%.1 A previous Frontline Gastroenterology debate ‘controversies in the management of portal hypertension’, covered updates in variceal bleeding.2 This article summarises current controversies and recent published research in the management of non-variceal UGIB. ### Risk scores: which score to use and does it alter clinical management? The debate began with an evaluation of the clinical utility of risk scoring systems in the assessment of UGIB. The Glasgow Blatchford score (GBS) is now the scoring system recommended by all the major recent international guidelines for identifying patients with very low-risk UGIB (GBS 0–1) who can be considered for outpatient management.3–5 Use of this score by clinicians in the emergency department (ED) or acute medical receiving unit allows early identification of low-risk patients who can avoid admission and have outpatient endoscopy arranged. The GBS gives junior doctors and our ED colleagues’ confidence to facilitate prompt decision making and avoid unnecessary hospital admissions. In 2019, Shung et al used machine learning to develop a model that was able to identify patients admitted with UGIB who were at risk of requiring hospital-based intervention or death.6 This was found to have greater specificity and sensitivity than all the current clinical risk scoring systems. Further data on the clinical utility of this …

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Twitter 辩论：上消化道出血管理的争议

关于 Frontline Gastroenterology 的一系列“争议……”Twitter 辩论中的最新一期由 AJS (@AdrianStanleyGI) 领导，讨论了急性上消化道出血 (UGIB) 的主题。这仍然是普通内科医生和胃肠病学家经常遇到的医疗紧急情况，住院死亡率约为 10%。1 先前的前线胃肠病学辩论“门静脉高压症的管理争议”，涵盖了静脉曲张出血的最新情况。2 本文章总结了当前在非静脉曲张 UGIB 管理方面的争议和最近发表的研究。### 风险评分：使用哪个评分，它会改变临床管理吗？辩论始于评估风险评分系统在评估 UGIB 中的临床效用。Glasgow Blatchford 评分 (GBS) 现在是近期所有主要国际指南推荐的评分系统，用于识别可考虑进行门诊治疗的极低风险 UGIB (GBS 0-1) 患者。3-5 使用该评分由急诊科 (ED) 或急症医疗接收单位的临床医生进行，可以及早识别可以避免入院并安排门诊内镜检查的低风险患者。GBS 让初级医生和我们的急诊科同事有信心促进迅速做出决策并避免不必要的住院。2019 年，Shung 等人使用机器学习开发了一个模型，该模型能够识别因 UGIB 入院且有需要医院干预或死亡风险的患者。6 这被发现比所有当前的临床风险评分系统具有更高的特异性和敏感性。关于这种临床效用的进一步数据……