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OPEN ACCESS OPEN ACCESS SPECIALIST REVIEW SPECIALIST REVIEW Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK Correspondence to: Dr Josh Orpen-­ Palmer, Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK; josh. orpen- palmer@ nhs. scot Cite this as: BMJMED 2022;1:e000202. doi:10.1136/ bmjmed-2022-000202 Received: 21 March 2022 Accepted: 15 July 2022 Update on the management of upper gastrointestinal bleeding Josh Orpen-­ Palmer ‍‍ , Adrian J Stanley ABSTRACT Upper gastrointestinal bleeding is a common emergency presentation requiring prompt resuscitation and management. Peptic ulcers are the most common cause of the condition. Thorough initial management with a structured approach is vital with appropriate intravenous fluid resuscitation and use of a restrictive transfusion threshold of 7-­ 8 g/dL. Pre-­ endoscopic scoring tools enable identification of patients at high risk and at very low risk who might benefit from specific management. Endoscopy should be carried out within 24 h of presentation for patients admitted to hospital, although optimal timing for patients at a higher risk within this period is less clear. Endoscopic treatment of high risk lesions and us...