Background: Gastrointestinal bleeding is a common and potentially serious problem, which remain a major reason for hospital admission. Chronic liver disease, portal hypertension and hematemesis are major problems in Egypt due to schistosomiasis and viral hepatitis. Subjects and Methods: This is a retrospective study of 1089 cases referred to Emergency Endoscopy Unit in Kasr El-Aini Hospital, Cairo University during the last 4 years (2002-2005). Results: From 1089 cases that underwent upper endoscopic management; we noted that the percentage of the patients who presented with upper gastrointestinal bleeding in the old age group were more than those in the middle age group with males predominance (71.9%). The study has shown that the commonest causes of upper gastrointestinal bleeding were oesophago-gastric varices (60.1%), ulcers (16.5%) & erosions (7.6%). Most of the cases were having grade II and III OV (47.3%) and (31.9%) respectively. The findings of double or triple upper gastrointestinal tract lesions were found in (19.7%) of cases of upper gastrointestinal bleeding. The commonest associated lesions occurring with oesophago-gastric varices were congestive gastropathy, gastric ulcer and duodenal ulcer. Conclusion: Chronic liver disease complicated by portal hypertension and oesophago-gastric varices is still a major problem and it is the main etiology of upper gastrointestinal bleeding in Egypt. Peptic ulcerations are the second cause of upper gastrointestinal bleeding in Egypt. The 6th decade is the most affected age group and males are more subjected than females to acute upper gastrointestinal bleeding. The findings of double or triple upper gastrointestinal tract lesions in cases of acute upper gastrointestinal bleeding stress the idea shared by many endoscopists that the detection of one lesion should not be the end of examination.