### What you need to know Bleeding from the upper gastrointestinal tract (oesophagus, stomach, and duodenum) occurs in approximately 100 per 100 000 people annually.12 It is a medical emergency associated with substantial mortality. A UK audit in 2007 found an overall mortality of 10%.3 This practice pointer provides a guide to the initial management of upper gastrointestinal bleeding and subsequent management of bleeding that results from peptic ulceration, the most common cause (box 1).6 Box 1 ### Causes of upper gastrointestinal bleeding45RETURN TO TEXT ### Assessment and resuscitation Patients may present with melaena, vomiting fresh blood, or with “coffee ground” vomiting (vomit can take on the appearance of coffee grounds when blood reacts with hydrochloric acid in the stomach). Abdominal pain may also be present. Fresh per rectal bleeding (haematochezia) can occur in major brisk bleeding.7 Assess the patient’s haemodynamic status. Look for visible signs of bleeding. Begin resuscitation in parallel with further clinical assessment. An approach to the initial management of patients with upper gastrointestinal bleeding is shown in the infographic. Early assessment by the intensive care team is recommended in the unstable patient, or where there is airway compromise (such as from haematemesis) or reduced level of consciousness.2 Obtain a medical history alongside a physical examination. Monitor physiological observations including heart rate, blood pressure, respiratory rate, oxygen saturation, and …