GI Bleeding: When to Go to the ER

Common causes of upper bleeding include stomach or duodenal ulcers (often linked to H. pylori infection or anti-inflammatory painkillers such as ibuprofen and aspirin), inflamed stomach lining, and enlarged veins in the esophagus or stomach (varices) in people with liver disease. Lower bleeding can come from diverticula (small pouches in the colon wall), hemorrhoids, polyps, colitis, or colon cancer. Blood thinners increase the risk and severity.

GI bleeding is a common reason for emergency visits and hospital admission. Many bleeds stop by themselves, but some are life-threatening, and it is not possible to tell at home which is which.

If bleeding starts during Ramadan fasting, Hajj or Umrah, do not delay going to the ER to continue fasting or the rituals; emergency treatment takes priority and religious scholars allow breaking a fast for medical need.

In the emergency department the team checks your pulse and blood pressure first, starts fluids through a drip, and takes blood tests (including blood count and blood group). Endoscopy, a thin flexible camera passed through the mouth (gastroscopy) or back passage (colonoscopy), finds the source of bleeding and often treats it at the same time. A CT scan of the blood vessels may be used if the source is not found.

Do not try to treat bleeding at home. Get emergency help first.

• Call emergency services or go to the nearest ER now if you have red-flag signs; do not drive yourself.

• Lie down and stay still while waiting; if you are vomiting, lie on your side.

• Take a list of your medicines, especially blood thinners and painkillers, to the hospital.

• Do not eat or drink anything before being seen, in case you need an urgent endoscopy.

• Quit smoking and limit alcohol after recovery.

Do not eat or drink if you are bleeding or if an emergency endoscopy may be needed.

• In hospital you will probably be kept nil by mouth until the doctors decide it is safe.

• Once recovered, eat regular meals and include iron-rich foods if you are anemic.

• Avoid alcohol and very spicy foods if you have a stomach ulcer, as advised by your doctor.

Medicines are given in hospital and adjusted afterwards.

• Intravenous acid-lowering medicine for suspected upper bleeding, and other specific medicines if varices are suspected.

• Blood transfusion may be needed if blood loss is large.

• Your team will decide whether to pause blood thinners or aspirin; never stop them yourself without advice.

• Treatment for H. pylori if found, and avoiding anti-inflammatory painkillers where possible.

• Iron treatment for anemia after bleeding.

Your doctors decide all medicines.

Endoscopy is the main way to find and stop bleeding.

• Endoscopy can stop bleeding using clips, heat, injection or bands (for varices).

• If endoscopy cannot control the bleeding, a radiologist can block the bleeding vessel (embolization).

• Surgery is rarely needed for bleeding that cannot be controlled otherwise.

• A follow-up endoscopy or colonoscopy may be planned to find the cause.

Most people recover well when they reach hospital in time and the cause is treated. Delay can be dangerous. After a bleed, your team will treat the cause and plan follow-up to lower the chance of it happening again.

• What caused my bleeding, and could it happen again?

• Do I need to change or pause any of my medicines, including aspirin or blood thinners?

• Do I need a repeat endoscopy or colonoscopy?

• Do I have anemia, and how should it be treated?

• Which symptoms should send me straight back to the ER?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.