Haematemesis and melaena

Upper gastrointestinal haemorrhage is common and carries a significant mortality. Peptic ulcer disease remains the most common aetiology, but varices are an important cause. The patient's history, physiology and blood results guide the timing of endoscopy and can disclose underlying liver disease. Resuscitation and risk assessment scoring are the main priorities in acute presentations. Patients who are haemodynamically unstable or have suspected bleeding varices should undergo endoscopy immediately after resuscitation. Endoscopy allows diagnosis and treatment as well as prognostic information. Peptic ulcers that are bleeding or show stigmata of recent haemorrhage are treated with dual endoscopic therapy and an intravenous proton pump inhibitor for 72 hours. Oesophageal varices are treated with endoscopic variceal band ligation and terlipressin. Gastric varices are treated with thrombin, glue injection or transjugular intrahepatic portosystemic shunt placement. Cirrhotic patients with acute upper gastrointestinal bleeding should also be given broad-spectrum antibiotics.