1. Introduction Upper gastrointestinal bleeding (UGIB) is a medical emergency characterized by bleeding originating from the upper gastrointestinal tract, including the esophagus, stomach, and duodenum. It may present as hematemesis, coffee-ground vomiting, or melena. Early diagnosis and appropriate management are essential to reduce complications and mortality. 2. Epidemiology Upper gastrointestinal bleeding is a common cause of emergency hospital admission. Its severity varies depending on the underlying cause, the amount of blood loss, the patient’s age, and associated medical conditions. Early assessment and risk stratification help determine the appropriate treatment and need for hospitalization. 3. Causes The most common causes of UGIB include: • Peptic ulcer disease. • Esophageal and gastric varices. • Erosive gastritis and duodenitis. • Esophagitis. • Mallory–Weiss tears. • Gastrointestinal malignancies. Risk factors include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, anticoagulants, and a history of liver disease or peptic ulcer disease. 4. Clinical Presentation Clinical manifestations may include: • Hematemesis (vomiting blood). • Coffee-ground vomitus. • Melena (black, tarry stools). • Dizziness, weakness, and fatigue. • Tachycardia and hypotension in severe cases. Severe bleeding may lead to hypovolemic shock, requiring immediate medical intervention. 5. Diagnosis Diagnosis begins with a detailed medical history, physical examination, and assessment of hemodynamic stability. Laboratory investigations include a complete blood count, coagulation profile, renal function tests, and blood grouping and crossmatching when necessary. The Glasgow-Blatchford Score (GBS) is used to assess the risk of intervention and the need for hospital admission. Esophagogastroduodenoscopy (EGD) is the primary diagnostic procedure and allows the identification of the bleeding source and, in many cases, simultaneous treatment. The Forrest classification is used to assess the risk of rebleeding in patients with peptic ulcer bleeding. 6. Treatment Initial Management Initial treatment focuses on stabilizing the patient’s condition, assessing the airway and circulation, establishing intravenous access, and administering fluids or blood products when indicated. Blood transfusion decisions should be based on hemoglobin levels, clinical condition, and ongoing blood loss. Non-Variceal Bleeding Proton pump inhibitors (PPIs) are commonly used in patients with suspected or confirmed peptic ulcer bleeding. Endoscopic treatment may be required to control active bleeding and reduce the risk of recurrence. Variceal Bleeding In suspected variceal bleeding, vasoactive medications and antibiotic prophylaxis are recommended. Endoscopic band ligation is commonly used for esophageal varices. Patients who do not respond to standard treatment may require additional interventions. 7. Complications and Prognosis Potential complications include recurrent bleeding, anemia, hypovolemic shock, and organ dysfunction. Prognosis depends on the severity of bleeding, the underlying cause, the patient’s general health, and the speed of diagnosis and treatment. 8. Conclusion Upper gastrointestinal bleeding is a potentially life-threatening condition that requires prompt assessment and appropriate management. Early risk stratification, timely endoscopy, and evidence-based treatment are essential to improve patient outcomes and reduce mortality. References 1. Laine L, et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. American Journal of Gastroenterology. 2021;116(5):899–917. 2. Gralnek IM, et al. Endoscopic Diagnosis and Management of Nonvariceal Upper Gastrointestinal Hemorrhage: ESGE Guideline Update 2021. Endoscopy. 2021;53(3):300–332. 3. de Franchis R, et al. Baveno VII—Renewing Consensus in Portal Hypertension. Journal of Hepatology. 2022;76(4):959–974. 4. Barkun AN, et al.Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Annals of Internal Medicine. 2019;171(11):805–822. 5. Siau K, et al. British Society of Gastroenterology-led Multisociety Consensus Care Bundle for the Early Clinical Management of Acute Upper Gastrointestinal Bleeding. Frontline Gastroenterology. 2020;11(5):311–323.