[The patient with hematemesis. What to do?].

In patients with hematemesis an emergency endoscopy has to be done as soon as possible. In ulcer disease emergency endoscopic treatment is indicated in ulcers with active bleeding or with visible vessels in the base of the ulcer. There is no significant difference in the efficacy between the various endoscopic methods of hemostasis. Gold standard in the treatment of acute variceal bleeding is the hemostasis by endoscopic ligation or sclerotherapy. Because of the very low complication rate variceal ligation is the therapy of choice in the prevention of variceal rebleeding. Especially in patients with preexisting portal hypertensive gastropathy an additional therapy with beta-blocker is recommended. In the prevention of first variceal bleeding a combination therapy with beta-blocker and nitrate is indicated in patients with big varices with red colour signs and in patients with decompensated liver cirrhosis (Child B).