Comprehensive review on the current management of upper-GI bleed

Upper gastrointestinal bleeding (UGIB) remains one of the common medical emergencies and a serious cause for morbidity and mortality worldwide. There have been significant advances in endoscopic therapy, pharmacological therapy and intensive care, but the outcome still seems to be variable and mainly influenced by the underlying etiology, comorbidities and timing of intervention. Vast regional differences exist in the epidemiological profile of UGIB in the Indian population. Upper GI bleed may manifest as self-limited bleeding to massive GI bleeding causing hemodynamic instability and mortality. The cornerstone of initial management includes early risk assessment, prompt resuscitation and appropriate triage. Endoscopy remains the cornerstone for both diagnosis and therapy since the origin of the bleed can be identified and treated. A wide range of endoscopic options are currently available, including injection therapy, thermal coagulation, mechanical devices, topical hemostatic agents and advanced rescue techniques. Radiologic and surgical interventions play a complementary role in patients with refractory or recurrent bleeding. Management strategies should take into account the clinical setting, available resources and local disease distributions. In the Indian setting, late presentation, poor access to emergency endoscopy and high burden of chronic liver disease present unique challenges. A systematic and step-wise approach with early stabilization, timely endoscopic intervention and proper management post-hemostasis improves outcomes. Ongoing refinement of protocols and wider dissemination of advanced endoscopic and radiological expertise are likely to further reduce re-bleeding and mortality associated with UGIB.