Upper GI Bleeding

The most common cause is a peptic ulcer, which is a sore in the lining of the stomach or duodenum, usually caused by the bacterium Helicobacter pylori or by anti-inflammatory painkillers (NSAIDs) and aspirin. Other causes include inflammation or erosions of the stomach or esophagus, enlarged veins (varices) in people with liver cirrhosis, a tear at the junction of the esophagus and stomach after forceful vomiting (Mallory-Weiss tear), abnormal blood vessels, and less often tumors. Alcohol, smoking, and blood thinners can add to the risk.

Upper GI bleeding is one of the more common reasons for emergency hospital admission related to the digestive system. It is more frequent in older adults and in people who take aspirin or anti-inflammatory painkillers, blood thinners, or who have liver cirrhosis. Most bleeds stop on their own or with treatment, but some are life-threatening.

Many people use over-the-counter painkillers such as ibuprofen or diclofenac, or herbal remedies, without telling their doctor. These can cause stomach bleeding, so please mention all of them. If you vomit blood or pass black stool during Ramadan or while on pilgrimage, break your fast if fasting and seek emergency care immediately; this is a medical emergency and takes priority.

In hospital, the team first checks your pulse, blood pressure and blood count, and stabilises you with fluids and blood if needed. The key test is upper endoscopy (gastroscopy), usually within about 24 hours of arrival, in which a thin flexible camera is passed through the mouth under sedation to find the source and treat it. Blood tests check hemoglobin, clotting and liver function. Your medicines, especially aspirin, anti-inflammatory tablets and blood thinners, are carefully reviewed. Stomach tissue is tested for Helicobacter pylori.

During a suspected bleed there is nothing to do at home except get help immediately. Afterwards, healthy habits help prevent another bleed.

• If you vomit blood or pass black stools, call an ambulance or go to the nearest emergency department immediately; do not drive yourself.

• Stop smoking and avoid alcohol.

• Do not take aspirin or anti-inflammatory painkillers unless your doctor has decided it is necessary.

• Do not stop prescribed heart or blood-thinning medicines on your own; tell the hospital team, who will decide what to do.

• Keep follow-up appointments and any repeat endoscopy you are given.

During an active bleed you will usually be told to eat and drink nothing until the endoscopy is done. Once treated, your doctor will advise when to restart food.

• Do not eat or drink while waiting for emergency care.

• After treatment, start with light meals as advised, then return to a balanced diet.

• Avoid alcohol and very spicy or acidic foods if they upset your stomach.

• Ask whether you need iron or vitamin B12 if you became anemic.

Hospital teams use medicines to control bleeding and prevent it returning. The choice depends on the cause, and your doctor decides on all medicines.

• Proton pump inhibitors (acid-reducing medicines such as omeprazole or pantoprazole) are commonly given, first into a vein and later as tablets.

• If Helicobacter pylori is found, a course of antibiotics is needed to cure it.

• If cirrhosis is the cause, other medicines to lower portal pressure and antibiotics are given.

• Blood transfusion and treatment to reverse blood thinners may be needed in selected cases.

• If you need aspirin or a blood thinner for a heart or clot condition, your doctor will decide when and whether to restart it.

Most upper GI bleeds are treated during the endoscopy itself.

• Endoscopic therapy: clips, heat (cautery), injection or a special powder is used to stop the bleeding point.

• Banding of enlarged veins (varices) when they are the cause.

• Interventional radiology can block the bleeding blood vessel when endoscopy does not work.

• Surgery is rarely needed and used when other treatments fail.

Most people recover well with prompt care. The outlook depends on the cause, how much blood was lost, your age and other illnesses. After treatment, the cause must be treated (for example, curing H. pylori or stopping a harmful painkiller) to prevent the bleeding from returning.

• What caused my bleeding, and was it treated during the endoscopy?

• Do I need a test or treatment for Helicobacter pylori?

• Which of my regular medicines (aspirin, painkillers, blood thinners) are safe to continue?

• How long should I take the acid-reducing medicine?

• Will I need a repeat endoscopy or checks for anemia?

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.