Upper GI bleeding is a common medical emergency with an incidence in the UK of 103 cases per 100,000 adults per year and is much more common in the elderly. A national audit on the management of upper GI bleeding in the UK, conducted between 1993 and 1994, showed 30-day mortality to be 14%. Several recommendations were made, including urgent endoscopy in high-risk patients and admission or early referral of patients with upper GI bleeding to gastroenterology teams. However, despite improvements in endoscopy, recognition of provoking factors and pharmacological interventions available when the audit was repeated in 2007 the mortality rate still remained significant at 10%.Rapid appropriate assessment and referral for early endoscopy can prevent morbidity and possibly reduce mortality. The use of reliable scoring systems has enabled early discharge and an evidence-based approach to subsequent secondary prevention can avoid recurrence.