To compare the ability of 4 bleeding risk scoring systems (Glasgow -Blatchford score, MAP, H3B2 and ABC scores ) in prediction of: Need of intervention, Re bleeding, Thirty-day mortality, length of hospital stay

Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency which has a variceal and non-variceal etiology. The non variceal etiology has higher incidence in many countries. In Egypt, non-variceal causes ranged from 26.1% to 61.6% among UGIB cases presented to the emergency departments of different University Hospitals. Guidelines recommend risk stratification early in the management of patients with acute UGIB to help triage patients into the appropriate level of care. Many scoring systems for UGIB were developed and validated from 1990s onwards. Their primary aim was to segregate the patients into low-risk and high-risk groups. High risk patients with UGIB includes those who reach some or all of the endpoints: requirement of blood transfusion, endo-therapeutic, surgical or radiological intervention to achieve hemostasis, re bleeding and mortality. Unfortunately, no single risk score has been shown to be accurate at measuring all relevant outcomes.

The most widely used score is Glasgow Blatchford "GBS" which is a pre endoscopic score. It is useful in prediction of therapeutic intervention for bleeding. More recently, other scores have been developed as ABC score which showed good performance for predicting mortality. MAP score highly predicted therapeutic intervention and mortality. H3B2 score predicted the need of urgent hemostasis.

Limited data are available on the validity of the new scoring systems in predicting the outcome of Egyptian non-cirrhotic patients with acute UGIB. Therefore, The investigators will conduct our study to shed some light on this topic.

Inclusion Criteria:

• Adult non cirrhotic patients
• patients more than 18 years old
• Hematemesis or coffee grounds vomiting.
• Melena with or without hematemesis.
• Blood in nasogastric tube in emergency unit.

Exclusion Criteria:

• Patients younger than 18 years old.
• Patients known to be cirrhotic.
• Patients presented with GIT bleeding but refuse to be examined by GIT endoscopy.

All patients within the current study will be subjected to:

I-Complete medical history. II-Through clinical examination. III-Laboratory investigations including Complete blood count (CBC) Liver profile (serum bilirubin, serum albumin, PT and INR) Blood urea and creatinine

IV-Abdominal Ultrasonography :

VI-Risk scoring systems :

At the time of admission, each of following 4 scores will be calculated and recorded (Glasgow Blatchford score, MAP score, H3B2 score and ABC score to validate outcome in the studied patients The Glasgow-Blatchford score "GBS" (6) MAP score, (11) The ABC score: (10) H3B2 score (12)

V-Upper GIT endoscopy :