Largest UK re-audit of upper gastrointestinal bleeding in 15 years highlights progress - and clear targets for improvement

Outcomes have improved despite older, more comorbid patients; gaps persist in pre-endoscopy risk stratification and restrictive transfusion.

Opening

A major UK-wide audit led by experts across the country, supported by the British Society of Gastroenterology (BSG) and NHS Blood and Transplant (NHSBT), has shown significant improvements in outcomes for patients admitted with acute upper gastrointestinal bleeding (AUGIB). The 2022 national audit, published in Gut, analysed data from more than 5,000 patients across 147 UK hospitals and compared the findings with the previous UK audit conducted in 2007. Despite an ageing and more medically complex patient population, the study found lower mortality and rebleeding rates, reflecting advances in emergency endoscopy and interventional radiology services. However, the audit also identified key areas for improvement, including wider use of pre-endoscopy risk assessment and greater adherence to restrictive blood transfusion strategies.

Key findings

• The largest UK re-audit of acute upper gastrointestinal bleeding (AUGIB) in 15 years analysed 5,141 patients from 147 hospitals, achieving an 86% national participation rate.
• Outcomes have improved since 2007: overall in-hospital mortality fell from 10% to 8.8%, and rebleeding rates from 13.3% to 9.7%.
• Patients are now more medically complex — two-thirds had comorbidities (up from 50% in 2007) and 15% had cirrhosis (up from 9% in 2007).
• More patients now receive endoscopy and interventional radiology for bleeding control, with inpatient endoscopy rates rising from 74% to 83% and the need for surgery falling from 1.9% to 0.7%, reflecting a shift towards less-invasive management.
• Blood transfusion practices remain inconsistent: nearly half (50%) of patients received red-cell transfusions, 38% within 24 hours or pre-endoscopy, and one in four early transfusions were potentially inappropriate.
• In haemodynamically stable patients transfused above 80 g/L, mortality was higher (adjusted OR 1.60, 95% CI 1.00–2.56), suggesting possible harm from liberal transfusion.
• Only 58% of patients had a pre-endoscopy risk score recorded, highlighting the need for more consistent early risk assessment to guide care and resource use.

Quotes

Dr Gaurav Nigam, Clinical Lead for the 2022 UK AUGIB Audit and NIHR Doctoral Research Fellow, University of Oxford:

“This audit provides the clearest national picture of gastrointestinal bleeding care in over 15 years. It shows that outcomes have improved, thanks to better access to endoscopy and radiological services, but also highlights where we can do better. Restrictive use of blood transfusions, early risk assessment, and investment in endoscopic training are key priorities to ensure every patient benefits from best-practice care. Importantly, this project was only possible because of the commitment of clinicians and trainees across 147 hospitals, their contribution has provided the evidence base to help shape the next phase of quality improvement in gastrointestinal bleeding care.”

Andy Douds, Chair of the AUGIB Steering Committee and Consultant Gastroenterologist at Norfolk and Norwich University NHS Trust/ Honorary Associate Professor at University of East Anglia:

“This seminal UK wide audit demonstrates a number of significant improvements in care but highlights areas where we need to do better. It was an enormous undertaking with many challenges post-Covid. I would like to express my sincere thanks  to Dr Nigam, fellow members of the multidisciplinary steering committee and all participating sites for their tireless commitment to this important audit. I must also thank the British Society of Gastroenterology for their resolute support."

Mike Murphy, Professor of Transfusion Medicine at the University of Oxford and Consultant Haematologist with NHS Blood & Transplant and Oxford University Hospitals NHS Foundation Trust:

“The 2022 audit provides a comprehensive assessment of current practices, patient outcomes and resource availability of acute gastrointestinal bleeding management across NHS hospitals. Since the previous audit in 2007, there have been new practice guidelines, and improvements in endoscopy and other aspects of service delivery. The audit’s findings highlight improvements in patient outcomes but raise concerns about the inappropriate use of red blood cell transfusions with the potential to increase the risk of rebleeding and mortality.”

Background

Acute upper gastrointestinal bleeding is a common medical emergency, causing around 60,000 hospital admissions each year in the UK. It accounts for about one in ten hospital blood transfusions, and although outcomes have improved in recent years, it remains a potentially life-threatening emergency.

The previous national audit in 2007 was a landmark study that revealed wide variation in care and informed key national recommendations, including NICE guidance and the 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on gastrointestinal bleeding.

The 2022 re-audit, coordinated by the National Comparative Audit of Blood Transfusion (NCA) at NHS Blood and Transplant, in collaboration with the British Society of Gastroenterology (BSG), the Royal College of Physicians (RCP), and specialist societies including the British Association for the Study of the Liver (BASL), the Association of Upper Gastrointestinal Surgeons (AUGIS), and the British Society of Interventional Radiology (BSIR), provides the most comprehensive assessment of practice since then.

A detailed national report, including local data for every participating hospital, has already been circulated to sites. Publication in Gut represents the next step in sharing the findings more widely, helping to identify real-world gaps in care and drive targeted quality-improvement initiatives across the NHS.

The audit’s success reflects the collective effort of clinicians, nurses, and trainees from 147 hospitals nationwide. Their contribution has generated the evidence needed to strengthen service planning, training in haemostatic endoscopy, and the safe, evidence-based use of blood products across the UK.

Acknowledgements

The 2022 UK AUGIB Audit Steering Committee thanks all the clinicians, nurses, and trainees who contributed data from 147 participating hospitals across the UK. This work was coordinated by the National Comparative Audit of Blood Transfusion (NCA) at NHS Blood and Transplant, in collaboration with the British Society of Gastroenterology (BSG), the Royal College of Physicians (RCP), and specialist societies including BASL, AUGIS, and BSIR. The audit was funded jointly by NHS Blood and Transplant and the British Society of Gastroenterology, with additional support from the National Institute for Health and Care Research (NIHR) for Dr Gaurav Nigam’s doctoral research fellowship (Award ID 302607).

Publication details

The full study, “Acute upper gastrointestinal bleeding in the UK: 2022 Audit Update,” has now been published in Gut (BMJ Journals, 2025).

Media contacts

For further information, interviews, or media enquiries, please contact:

BSG Office: [email protected]

Corresponding Authors: Dr Gaurav Nigam – [email protected]; Dr Andy Douds - [email protected]

UK 2022 Acute Upper Gastrointestinal Bleeding (AUGIB) Audit

The UK 2022 Acute Upper Gastrointestinal Bleeding (AUGIB) Audit highlights significant advancements in the management and organisational practices of AUGIB across UK hospitals since the last national audit in 2007. Conducted as part of the National Comparative Audit of Blood Transfusion, this extensive study involved key stakeholders, including the British Society of Gastroenterology (BSG), NHS Blood and Transplant (NHSBT), the Royal College of Physicians (RCP), the British Association for the Study of the Liver (BASL), the Association of Upper GI Surgeons (AUGIS), and the British Society of Interventional Radiology (BSIR). The audit assesses clinical care, transfusion practices, and hospital resources to evaluate current standards and identify areas for improvement in AUGIB management across UK hospitals.

Full Audit Reports

The full audit reports provide detailed insights into clinical care, organisational capabilities, and training provisions:

📄 UK 2022 Comparative Audit of Acute Upper Gastrointestinal Bleeding (AUGIB) and the Use of Blood – A comprehensive overview of clinical and organisational findings.

📄 2022 AUGIB Trainee and Trainers Survey Report  – Perspectives on training in the endoscopic management of AUGIB.

Related Publications

📄 Gaps in acute upper GI bleed (AUGIB) endoscopy training: A UK trainees and trainers’ survey – A focused analysis on AUGIB training challenges and recommendations for improvement.

Watch Prof Adrian Stanley’s interview with Dr Gaurav Nigam discussing his main talk on the ‘Summary of key findings from the interim analysis of the UK Acute Upper Gastrointestinal Bleeding Audit 2022’ at BSG LIVE’23 here.