Background: Hematemesis is a major presentation of acute upper gastrointestinal bleeding (UGIB) and may reflect either nonvariceal or variceal disease. Recent evidence has refined risk stratification, transfusion practice, timing of endoscopy, endoscopic hemostasis, and escalation pathways. Objective: To provide a current review of the causes, clinical assessment, endoscopic diagnosis, management, and outcomes of hematemesis using recent literature, with particular emphasis on evidence published in 2025-2026. Methods: This narrative evidence update synthesizes recent prospective studies, multicentre data, systematic reviews, and contemporary endoscopy guidance. It is not presented as a new 2025-2026 patient cohort. Results: Recent studies confirm substantial geographic variation in the causes and outcomes of UGIB. A 2026 publication from a 93-centre Indian task force reported 10,564 analyzable UGIB patients: 61.1% had nonvariceal and 38.9% variceal bleeding; 30-day mortality was 2.8% and 3.67%, respectively. A separate prospective cohort published in 2025 found varices (33.3%), erosive gastritis/duodenitis (27.7%), and peptic ulcers (21.5%) to be the leading endoscopic findings, with 17.4% six-week mortality in that low-resource setting. Conclusion: Hematemesis remains a high-priority emergency. Modern care is based on early stabilization, validated risk assessment, appropriately timed endoscopy, etiology-specific hemostasis, and selective use of interventional radiology or surgery when endoscopic control fails.