Gastrointestinal ulcer bleeding may require different management based on the volume of bleeding.

With significant bleeding, the condition becomes critical and rapidly changing. Priorities include anti-shock measures, rapid replenishment of blood volume, maintaining a supine position, keeping the airway clear to avoid aspiration during vomiting, providing oxygen if necessary, fasting during active bleeding, closely monitoring the patient's vital signs, immediate blood typing and cross-matching, promptly establishing an effective intravenous infusion pathway, and replenishing blood volume. Medications such as PPIs or H2 receptor antagonists can be used; the former should be chosen for severe bleeding and administered intravenously.

About 80% of patients with gastrointestinal ulcer bleeding may stop bleeding without any special treatment, while the remaining patients may experience persistent bleeding or rebleeding. Emergency gastroscopy is crucial to determine if the patient is at high risk of rebleeding or has ongoing bleeding and can include therapeutic endoscopic interventions such as drug injections, electrocoagulation, and the use of hemostatic clips. If endoscopic treatment fails, the gastric and duodenal arteries may be embolized via arterial intervention. If pharmacologic, endoscopic, and interventional treatments cannot control the bleeding, and there is ongoing significant blood loss threatening the patient's life, surgical treatment may be necessary.

(Specific medications should be administered under the guidance of a physician.)