Upper GI Bleeding

Upper gastrointestinal (GI) bleeding is bleeding that occurs in the upper digestive tract — most commonly the oesophagus (gullet), stomach, or duodenum (the first part of the small intestine). It can range from mild to life-threatening.

Upper GI bleeding is always taken seriously because it can lead to significant blood loss and shock. Prompt assessment is important, especially if symptoms are severe or worsening.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and investigation, with urgent escalation pathways where needed.

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Common causes of upper GI bleeding

Upper GI bleeding can be caused by several conditions, including:

• Peptic ulcers (stomach or duodenal ulcers)
• Gastritis/duodenitis (inflammation of the stomach/duodenal lining)
• Oesophagitis (inflammation of the oesophagus), often linked to reflux
• Tears at the top of the stomach/oesophagus after severe vomiting/retching
• Varices (swollen veins in the oesophagus or stomach, often linked to liver disease)
• Abnormal blood vessels (vascular malformations)
• Upper GI cancers (less common, but important to rule out in some cases)

Certain medicines can increase bleeding risk, particularly:

• Anti-inflammatory painkillers (NSAIDs)
• Aspirin
• Blood thinners / anticoagulants
• Some steroid medicines (especially with NSAIDs)

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Symptoms of upper GI bleeding

Symptoms depend on how fast and how much bleeding is occurring. Common symptoms include:

• Vomiting blood (bright red, or dark “coffee-ground” material)
• Black, tarry stools (melaena)
• Blood in stools (less common with upper GI bleeding, but can occur with heavy bleeding)
• Dizziness, fainting, or feeling lightheaded
• Weakness, fatigue, or shortness of breath
• Pale, clammy skin
• Fast heartbeat or palpitations
• Upper abdominal pain or indigestion symptoms (not always present)

Some people have no pain and notice only black stools or increasing tiredness.

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When to seek urgent help

Call 999 or go to A&E immediately if you have:

• Vomiting blood (any amount)
• Black, tarry stools
• Fainting, collapse, severe dizziness, or confusion
• Severe weakness, chest pain, or breathlessness
• Rapid heartbeat with feeling unwell

Do not drive yourself if you feel faint or unwell.

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Diagnosis at Royal Buckinghamshire Hospital

Assessment focuses on confirming the source of bleeding, how severe it is, and treating it quickly.

You may have:

• A detailed history (symptoms, medications such as NSAIDs/blood thinners, alcohol intake, known ulcers/liver disease)
• Examination and observations (blood pressure, pulse, signs of dehydration or shock)
• Blood tests to check haemoglobin (anaemia), clotting, kidney function, and other markers
• Endoscopy (gastroscopy) to identify the bleeding source and, in many cases, treat it at the same time
• Imaging or specialist referral in selected cases, depending on findings

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Treatment & management

Treatment depends on severity and the cause, and may include:

Immediate stabilisation (if needed)

• Intravenous fluids
• Blood transfusion if blood loss is significant
• Medication review and temporary adjustment of blood thinners/antiplatelets where clinically appropriate
• Oxygen and monitoring when required

Medication treatment

• Acid-suppressing medication (commonly used when ulcers are suspected)
• Treatment for infection-related ulcers where relevant
• Specific treatments if varices are suspected (managed via urgent specialist pathways)

Endoscopic treatment

During gastroscopy, doctors may treat bleeding using techniques such as:

• Clips
• Injection therapy
• Heat/thermal therapy
• Banding for varices (in specialist pathways)

Treating the underlying cause

Once bleeding is controlled, the next step is prevention:

• Managing ulcer risk and reviewing NSAID use
• Protecting the stomach lining if ongoing risk medicines are needed
• Addressing reflux-related inflammation
• Further investigation if there are concerning features (for example unexplained weight loss or persistent symptoms)

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Recovery and follow-up

Follow-up depends on the cause and severity. You may need:

• Repeat blood tests to ensure recovery from anaemia
• A treatment course to heal ulcers/inflammation
• A follow-up gastroscopy in selected cases
• Advice on medication changes and risk reduction (including smoking/alcohol guidance where relevant)

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If you have symptoms that could indicate upper GI bleeding — especially black stools, vomiting blood, or dizziness — seek urgent medical help. For ongoing upper abdominal symptoms or concerns about ulcer risk (particularly if you take anti-inflammatory medicines), contact Royal Buckinghamshire Hospital for assessment and guidance.