Clinical Spectrum and Outcomes of Acute Upper Gastrointestinal Bleeding: A Prospective Comparative Study Between Elderly and Younger Adults.

Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency with age-related variation in etiology and outcomes. This study prospectively compared the clinical profile, endoscopic findings, and outcomes of UGIB in elderly (>60 years) and non-elderly (≤60 years) patients. Methodology A prospective observational study was conducted at a tertiary care hospital in Pakistan between December 1, 2023, and December 31, 2025. A total of 162 patients undergoing upper gastrointestinal endoscopy were equally stratified by age. Risk stratification was performed using the Rockall score, and outcomes, including rebleeding, transfusion requirements, and in-hospital mortality, were analyzed. Results Elderly patients had significantly higher Rockall scores (5.87 ± 1.89 vs. 3.68 ± 2.42; p < 0.001) and predominantly non-variceal bleeding, while non-elderly patients more frequently had variceal bleeding. Rebleeding occurred in one-third of patients, predominantly from variceal sources. Overall mortality was low (4.3%) and was associated with higher Rockall scores. Conclusions UGIB demonstrates distinct age-related patterns in etiology and severity. Rockall-based risk stratification and timely endoscopy remain essential tools for effective, age-tailored management.