Upper Gastrointestinal Bleeding Treatments, Causes | Upper GI Bleeding

Upper Gastrointestinal Bleeding

Acute gastrointestinal tract hemorrhage is a common emergency. The mortality figures have remained constant at 10% or more despite advances in methods of diagnosis and treatment of upper GI bleeding.

Causes of Upper GI Bleeding

Causes may be local or general. Causes of upper gastrointestinal tract bleeding are numerous and these can be classified as follows:

A.    Local causes- according to the site of hemorrhage

1.   Esophagus

  • Gastro-esophageal bleeding- this is a very common cause in this country and probably constitutes about 20% or more of upper gastrointestinal (GI) bleeding.
  • Reflux esophagitis.
  • Hiatus hernia.
  • Mallory-Weiss syndrome- this may cause mild, moderate or even massive bleeding contributing about 5-15% of upper GI bleeding.
  • Barrett’s ulcer.
  • Polyps and carcinoma.
  • Achalasia and foreign bodies.

2.    Stomach and duodenum

  • Chronic duodenal ulcer (33%). Hemorrhage usually occurs from ulcers situated in the posterior wall of the first part of the duodenum.
  • Chronic gastric ulcer (20%). Mostly the ulcers in the lesser curvature and posterior wall of the stomach bleed.
  • Multiple erosions and acute peptic ulcer (10-25%). Erosions are usually multiple. Erosions may occur in burns (Curling ulcer), in the head injury (Cushing ulcer), CVA, septicemia, respiratory and liver failure. Drugs and alcohol may also produce erosion.
  • Tumors- polyps and carcinoma. Other rare tumors e.g. lymphoma and leiomyoma may cause bleeding.

3.    Small intestine

Though by convention this group should not be included, yet when these only produce haemetemesis (vomiting of blood), these may be included as cause of upper GI bleeding.

  • Very rarely Meckel’s diverticulums may present with haemetemesis.
  • Polyps.
  • Vascular malformations.
  • Various tumors.

A.    General Causes

  • Hemorrhagic disorders e.g. thrombocytopenia, purpura, hemophilia, pernicious and other anemia, liver diseases, amyloidosis, Turner’s syndrome, Kaposi’s sarcoma etc.
  • Ingestion of drugs e.g. steroids, non-steroidal anti-inflammatory agents etc.
  • Salicylates and alcohol.

Of the various causes mentioned above the common are

  • Chronic peptic ulcer,
  • Acute ulcers and multiple erosions,
  • Esophageal bleeding and
  • Mallory-Weiss syndrome