Summary

Upper gastrointestinal bleed (UGIB) presents with haematemesis, melaena, or both. Common causes include peptic ulcer disease (most common), oesophageal varices, Mallory-Weiss tear, and malignancy. Risk stratification using Glasgow-Blatchford or Rockall scores guides management. Treatment involves resuscitation, IV PPI, and urgent endoscopy within 24 hours with appropriate intervention.

Key Facts

• Definition: Bleeding from a source proximal to ligament of Treitz
• Incidence: 50-150 per 100,000 per year
• Pathognomonic: Haematemesis and/or melaena
• Gold Standard Investigation: OGD within 24 hours
• First-line Treatment: Resuscitation + IV PPI + endoscopy
• Prognosis: Mortality 5-10%

Clinical Pearls

Transfusion Pearl: Restrictive transfusion (Hb target 70-80) improves outcomes.

Variceal Pearl: Terlipressin + antibiotics before endoscopy if varices suspected.

Blatchford Pearl: Score 0 = very low risk, may not need admission.

Glasgow-Blatchford Score

• Urea, Hb, systolic BP, pulse, melaena, syncope, liver disease, heart failure
• Score 0 = safe for outpatient management

Viva Points

"UGIB: peptic ulcer most common cause. Blatchford score 0 = low risk. Restrictive transfusion (Hb 70). IV PPI. OGD within 24h. Terlipressin if varices."

Last Reviewed: 2026-01-01 | MedVellum Editorial Team