Criteria for persistent (continued) upper gastrointestinal bleeding - one or more of the following:
(1) failure to control the source of bleeding during endoscopy
(2) bloody nasogastric aspirate (or vomiting blood or melena, below)
(3) shock with tachycardia (pulse > 100 beats per minute) and/or systolic hypotension (systolic blood pressure < 100 mm Hg) and/or drop in hemoglobin (see below)
(4) need for > 4 units of blood in 6 hours (requirement of substantial blood and fluid replacement to maintain blood pressure)
The presence of persistent bleeding is an indication for an intervention (endoscopy, surgery or percutaneous embolization).
Criteria for recurrent upper gastrointestinal bleeding - one or more of the following after an initial stabilization for >= 24 hours
(1) vomiting of blood and/or melena
(2) shock and/or drop in hemoglobin >= 0.2 g/dL
The diagnosis of recurrent bleeding requires confirmation by endoscopy, with demonstration of visible bleeding or stigmata of recent bleeding.
