Evaluation and Management of Upper Gastrointestinal Bleeding in Adults: A Systematic Review
Osman Suliman *
Faculty of Medicine, University of Medical Sciences and Technology (UMST) Khartoum, Sudan.
Fatimah Alotaibi
Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
Yara Alhoivi
Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
Asrar Alrashidi
Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
Arwa Alshanqiti
Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
Bassam Alhoivi
Faculty of Medicine Taibah University, Al-Madinah, Saudi Arabia.
Sara Altom
Department of Basic Sciences, Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
Eisa Mohamed
Information Technology Department, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Background: Upper gastrointestinal bleeding (UGIB) is still a major medical emergency that causes a lot of illness and death around the world. Even though diagnostic and therapeutic methods have gotten better, it is still very hard to find patients early, assess their risks, and give them the best care possible in clinical practice.
Objective: Our objective was to conduct a systematic review of the current evidence regarding the assessment and management of upper gastrointestinal bleeding in adults, with a particular focus on diagnostic techniques, risk evaluation tools, pharmacological and endoscopic interventions, and their respective outcomes.
Methods: We conducted a systematic review of the literature in PubMed, Scopus, Web of Science, the
Cochrane Library, and Google Scholar for studies published from January 2010 to September 2025. The analysis included randomized controlled trials, cohort studies, systematic reviews, and metaanalyses that examined the assessment and management of adult upper gastrointestinal bleeding (UGIB). We got information about the cause, how accurate the diagnosis was, risk stratification models (like Glasgow-Blatchford and Rockall), treatment methods, and clinical outcomes. Quality was assessed using the PRISMA framework.
Results: A total of 42 studies qualified for inclusion. Peptic ulcer disease and variceal bleeding were the main causes of UGIB in most cases. Early endoscopy conducted within 24 hours was associated with reduced rates of rebleeding and mortality. Proton pump inhibitors (PPIs) given before and after an endoscopy improved the results of hemostasis. Endoscopic procedures such as hemoclipping and band ligation were also highly effective in achieving initial hemostasis (>90%). Risk scoring systems improved triage and management decisions, allowing low-risk patients to leave the hospital sooner. The best results for patients came from using a combination of drugs, endoscopy, and, in some cases, surgery or radiology.
Conclusion: To treat UGIB in adults effectively, you need to quickly figure out what's wrong, provide the right resuscitation, do an endoscopic procedure early on, and use medications that are based on evidence. Using more than one risk stratification tool makes it easier for doctors to make decisions, improves the prognosis, and puts less strain on the healthcare system. More thorough research is needed to find the best times for interventions and test new endoscopic and drug-based methods.
Keywords: Upper gastrointestinal bleeding, endoscopy, proton pump inhibitors, variceal bleeding, peptic ulcer, risk stratification, hemostasis, management