Acute upper gastrointestinal bleeding (AUGIB) is a major cause of emergency hospital admission worldwide, with patient outcomes strongly influenced by early risk assessment and timely endoscopic intervention. While international guidelines are well established, their real-world implementation outside tertiary centers—particularly in district-level and resource-constrained hospitals—remains less well characterized. This study evaluated the clinical profile, endoscopic findings, management strategies, and outcomes of patients presenting with AUGIB in a United Kingdom district general hospital to identify lessons applicable to global clinical practice. We conducted a retrospective observational study of adult inpatients who underwent upper gastrointestinal endoscopy for hematemesis and/or melena between January and December 2024, collecting data on demographics, Glasgow-Blatchford Score (GBS), hemodynamic status, endoscopic diagnoses, therapeutic interventions, timing of endoscopy, re-bleeding, and in-hospital outcomes. Sixty-four patients were included (mean age 72.1 years; 71% male). Nonvariceal bleeding accounted for 92% of cases, most commonly due to peptic ulcer disease, while variceal bleeding was identified in 8%. Risk stratification using GBS was performed in all patients, enabling structured triage and decision-making. Therapeutic endoscopy was required in 25% of nonvariceal bleeds, predominantly using dual or triple hemostatic modalities. Despite limited out-of-hours endoscopy availability, 66% of patients underwent endoscopy within 24 hours. Clinical outcomes were favorable, with a low re-bleeding rate of 3.1% and no in-hospital mortality. These findings demonstrate that high-quality, guideline-based AUGIB management can be delivered effectively in a district hospital setting, achieving excellent outcomes without the infrastructure of a tertiary center. Systematic risk stratification, timely endoscopy, and multimodal therapy are key, globally transferable drivers of success.

Dr. Rajesh K. Gurunathan is a third-year Internal Medicine trainee working as a Medical Registrar in the National Health Service (NHS), United Kingdom. He is actively involved in the acute management of complex inpatient medical conditions, with a particular clinical interest in gastroenterology and hepatology. Dr. Gurunathan is the co–first author of an original research study conducted in a United Kingdom district general hospital, which evaluated the clinical profile, endoscopic findings, and outcomes of patients presenting with acute upper gastrointestinal bleeding. This work has been published in a PubMed-indexed, peer-reviewed journal, reflecting his strong commitment to evidence-based clinical practice and translational research. His academic interests include acute gastrointestinal emergencies, risk stratification, endoscopic outcomes, and the implementation of guideline-driven care in real-world and resource-variable healthcare settings. He aims to continue integrating high-quality clinical research with frontline medical practice to improve patient outcomes and healthcare delivery.