More than 90% of all acute gastrointestinal bleeding is localized in the upper gastrointestinal tract. Manifestation of bleeding elucidates a life-threatening situation. An immediate planned approach with rapid resuscitation from shock, localization of the source of bleeding, estimation of the intensity of bleeding, and local control is necessary. The outcome is influenced more by patient factors and type of bleeding than by therapy. If local control of the source of bleeding is not feasible, a definitive procedure must be employed rapidly.