Dietary Management for Patients with Upper Gastrointestinal Bleeding

During the acute phase of upper gastrointestinal bleeding, patients should remain strictly nil per os (NPO), meaning no food or fluids by mouth. The dietary care plan should be introduced gradually based on the recovery timeline, as outlined below:

Day-by-Day Dietary Progression

Day 1

Patients may begin with small sips of warm water, approximately 300–400 mL total, consumed in divided amounts. This step helps assess whether the patient experiences any gastrointestinal symptoms such as abdominal pain, bloating, nausea, vomiting, hematemesis (vomiting blood), or melena (black, tarry stools). If any of these symptoms occur, it may indicate that the bleeding has not fully stopped or that the underlying condition is not yet under control. In such cases, dietary advancement should be paused temporarily.

Day 2

On the second day, patients can start consuming small amounts of bland, easily digestible liquids such as thin rice water or diluted rice porridge. These foods are gentle on the digestive system and help reintroduce nutrients without causing irritation.

Day 3

By the third day, patients can progress to thicker rice porridge, soft dumpling soup, or well-cooked soft noodles. These foods are still mild and easy to digest while providing more caloric value and nutrients.

Day 4–5

From the fourth to fifth day, patients can begin incorporating small portions of boiled vegetables without added oil. These vegetables can be cooked directly into the rice or noodles to maintain a soft texture and enhance nutritional intake.

After One Week

By the end of the first week, patients can gradually introduce soft staple foods and begin adding small amounts of fat to their meals. Options may include lean meats or lightly sautéed vegetables, which help restore energy and support tissue healing.

General Dietary Guidelines During Recovery

Once the bleeding has resolved, it is essential to reintroduce food gradually and carefully. Meals should be small and frequent, with each serving being about 5–7 on a fullness scale of 10. Overeating should be avoided at every meal. For patients without diabetes, eating smaller meals more frequently throughout the day is highly recommended to support digestion and nutrient absorption.

Additionally, patients should gradually increase the variety of foods they consume. Introducing 1–2 new food items per day can help identify any foods that may cause discomfort or intolerance, while steadily progressing toward a normal, balanced diet.