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Approach to acute upper gastrointestinal bleeding in adults - UpToDate

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Patients with acute upper gastrointestinal (GI) bleeding commonly present with hematemesis (vomiting of blood or coffee-ground-like material) and/or melena (black, tarry stools), though patients with large-volume upper GI bleeding may also present with hematochezia (red or maroon blood with stool). The initial evaluation of patients with acute upper GI bleeding involves an assessment of hemodynamic stability and resuscitation if necessary. Diagnostic studies (usually endoscopy) follow, with the goals of diagnosis, and when possible, treatment of the specific disorder. The diagnostic and initial therapeutic approach to patients with acute upper GI bleeding will be reviewed here. While there is variability among guidelines, this approach is generally consistent with a multidisciplinary international consensus statement updated in 2019, a 2012 guideline issued by the American Society for Gastrointestinal Endoscopy, a 2021 guideline issued by the American College of Gastroenterology, a 201

Approach to acute upper gastrointestinal bleeding in adults Authors:John R Saltzman, MD, MASGE, FACG, AGAF, FACPIan M Gralnek, MD, MSHS, FESGE, FASGE Section Editor:Loren Laine, MD Deputy Editors:Han Li, MDClaire Meyer, MD Literature review current through: Aug 2026. This topic last updated: Jun 04, 2026. INTRODUCTION Upper gastrointestinal (GI) bleeding refers to GI blood loss proximal to the ligament of Treitz (the duodenojejunal junction) [1]. Patients with acute upper GI bleeding commonly present with hematemesis (vomiting of red blood or coffee-ground-like material) and/or melena…

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