Upper GI Bleeding: Ulcers, Varices, and How to Stabilize Quickly

When someone vomits blood or passes black, tarry stools, it’s not just unpleasant-it’s a medical emergency. Upper GI bleeding can come from a simple stomach ulcer or something far more dangerous like ruptured varices in the liver. The difference between life and death often comes down to how fast you recognize it and how quickly you act.

What Exactly Is Upper GI Bleeding?

Upper gastrointestinal bleeding means blood is coming from somewhere in the upper part of your digestive tract-your esophagus, stomach, or the first part of your small intestine (duodenum). It’s not rare. About 100 out of every 100,000 adults in the U.S. experience it each year. That’s roughly 300,000 hospitalizations annually. And it’s getting more common as the population ages. People over 80 are three times more likely to bleed than those under 50.

The most common cause? Peptic ulcers. They account for 40 to 50% of cases. These are open sores in the stomach or duodenum, often caused by H. pylori bacteria or long-term use of NSAIDs like ibuprofen or aspirin. The second big culprit? Esophageal varices-swollen veins in the esophagus, usually from advanced liver disease. They’re less common but far more deadly. About 1 in 5 people with variceal bleeding won’t survive the next six weeks.

Other causes include erosive gastritis, Mallory-Weiss tears (from violent vomiting), esophagitis, and even stomach cancer. And yes, even common medications like SSRIs (antidepressants) can double your risk of bleeding. It’s not just about what you eat-it’s about what you take, what you’ve had, and what’s going on inside your body.

Recognizing the Signs Before It’s Too Late

You can’t ignore these symptoms. They’re your body screaming for help.

• Hematemesis: Vomiting bright red blood means active bleeding. If it looks like coffee grounds, the blood has been sitting in your stomach-still serious, but maybe a little slower.
• Melena: Black, sticky, foul-smelling stools. That’s digested blood. It doesn’t mean it’s minor-it means the bleed is upstream, likely in the stomach or duodenum.
• Hematochezia: Bright red or maroon stools. This can happen with massive bleeding, when blood rushes through too fast to be digested.
• Dizziness, fainting, rapid heartbeat: Your body is trying to compensate for lost blood. A heart rate over 100 beats per minute and systolic blood pressure below 90 mmHg are red flags.

One patient on Reddit described waking up at 3 a.m. coughing up coffee-ground material. He ended up in the ER, got three units of blood, and stayed in the hospital for eight days. Another person had black stools dismissed as “iron supplements” for two weeks-until they collapsed. Their hemoglobin was 5.8. Normal is 12 to 16. That’s life-threatening.

Don’t wait. Don’t assume it’s heartburn. Don’t think it’ll go away. If you’re vomiting blood or passing black stools, go to the ER. Now.

How Doctors Assess the Danger: The Glasgow-Blatchford Score

Not every case needs the same level of urgency. That’s why doctors use the Glasgow-Blatchford score. It’s not a guess. It’s based on hard numbers:

• Hemoglobin level (below 12.9 g/dL for men, below 11.9 for women)
• Systolic blood pressure (below 100 mmHg)
• Pulse rate (above 100 bpm)
• Presence of melena
• History of syncope (fainting)
• Signs of liver or heart disease

A score of 2 or higher means you need hospital care. A score of 0? You might be able to go home safely. In fact, studies show that 15% of patients with upper GI bleeding can be managed without hospitalization if their score is low. That’s a game-changer.

But here’s the catch: doctors who rely only on symptoms or guesswork miss the mark. One expert said 30% of low-risk patients get unnecessary treatments because they skip the score. That’s why it’s now standard in every major hospital in the U.S. and Europe.

What Happens in the ER: Stabilization First

Before you even get an endoscopy, your body has to be stabilized. No exceptions.

• IV fluids are started immediately to maintain blood pressure.
• Oxygen is given if you’re dizzy or struggling to breathe.
• Blood tests: CBC to check hemoglobin, INR to see how well your blood clots, and BUN-to-creatinine ratio. If that ratio is above 30:1, it’s 69% likely you’re bleeding from the upper GI tract.
• Transfusions? Only if your hemoglobin is below 7 g/dL or you’re symptomatic. Don’t over-transfuse. Studies show keeping hemoglobin between 7 and 9 g/dL is safer than pushing it to 10 or higher.

Each unit of packed red blood cells raises your hemoglobin by about 1 g/dL. Simple math. No guesswork.

Endoscopy: The Most Important Test

The gold standard for diagnosis and treatment? Esophagogastroduodenoscopy (EGD). This is a camera on a tube that goes down your throat to see the source of bleeding.

Timing matters. The American College of Gastroenterology says: get it done within 24 hours. But the best outcomes? When it’s done within 12 hours. One study showed mortality drops by 25% when endoscopy happens early.

During the procedure, doctors use the Forrest classification to rate the bleeding risk:

• Class Ia: Spurting blood. 90% chance of rebleeding without treatment.
• Class Ib: Oozing. 50% risk.
• Class IIa: Visible vessel. Also 50% risk.

If you’re in Class I or II, they don’t just look-they treat. Right then and there.

Treatment: Ulcers vs. Varices

How you treat depends entirely on what’s bleeding.

For ulcers and non-variceal bleeding:

• High-dose IV proton pump inhibitors (PPIs): 80 mg bolus, then 8 mg/hour infusion. This cuts rebleeding from 22.6% to 11.6%.
• Endoscopic therapy: Epinephrine injection to shrink blood vessels, then either heat (thermal coagulation) or clips (hemoclips) to seal the spot. Success rate? 90-95%.

For esophageal varices:

• Vasoactive drugs: Terlipressin or octreotide. These drugs shrink the veins and reduce pressure in the liver.
• Antibiotics: Ceftriaxone 1g daily. Prevents infections that can kill you when your liver is already failing.
• Band ligation: Rubber bands placed around the varices. It’s the preferred method. Reduces rebleeding from 60% to 25%.

Sclerotherapy (injections to harden veins) used to be common. Now it’s mostly replaced by banding. Why? Better results, fewer complications.

What’s New in 2026

Medicine doesn’t stand still. Two big advances are changing the game:

Hemospray: This is a fine powder sprayed directly onto bleeding sites during endoscopy. It forms a physical barrier. In tough cases where clips or heat don’t work, it stops bleeding in 92% of cases.

AI-assisted endoscopy: New systems use artificial intelligence to spot tiny signs of bleeding that human eyes miss. In one trial, AI detected bleeding with 94.7% accuracy-compared to 78.3% for experienced doctors. But here’s the catch: current AI tools are less accurate in Black and Hispanic patients because the training data was mostly from white populations. That’s a problem researchers are fixing now.

The NIH is running a massive study called UGIB-360, tracking 10,000 patients to build personalized risk models using genetics, gut bacteria, and clinical history. Results are expected late 2025. This could mean your treatment is tailored to your body-not just your symptoms.

What Patients Do Afterward

Surviving the bleed is only half the battle. The other half is preventing the next one.

• Stop NSAIDs. If you need pain relief, switch to acetaminophen. Always check with your doctor first.
• If you have H. pylori, you’ll get antibiotics to clear it. This cuts ulcer recurrence by 90%.
• Alcohol? Cut it out. Especially if you have liver disease.
• Antidepressants? Don’t stop them on your own. Talk to your doctor. The risk is real, but so is the risk of untreated depression.

A 2022 study found 68% of patients were anxious about bleeding again within 30 days. Over 40% changed their diet-cutting caffeine, spicy food, alcohol-without being told to. That’s good. But 31% stopped their meds without consulting anyone. That’s dangerous.

Follow-up is key. Hospitals that use a full “Upper GI Bleed Bundle”-rapid assessment, risk scoring, early PPIs, endoscopy within 12 hours, and follow-up within 72 hours-cut their 30-day death rate from 8.7% to 5.3%.

Final Reality Check

Upper GI bleeding is scary. But it’s not mysterious. It’s predictable. It’s treatable. And it’s preventable in most cases.

If you’re over 65, take NSAIDs regularly, have liver disease, or have a history of ulcers-you’re at higher risk. Know the signs. Don’t wait. Don’t dismiss black stools or vomiting. Get checked.

Doctors aren’t infallible. One patient was told his black stools were from iron pills. He collapsed. His hemoglobin was 5.8. He survived. But not everyone does.

Know your numbers. Know your risks. And if something feels wrong-trust your gut. Because sometimes, your gut is trying to tell you something life-saving.