Upper Gastrointestinal Bleeding

Upper Gastrointestinal Bleeding

• Each year, 300,000 hospital admissions for UGI bleeding
• Approximately 60% of patients are older than 65 years
• Mortality rate has been 6% to 13% for past 45 years

Etiology and Pathophysiology

• Most serious loss of blood from UGI characterized by sudden onset
• Insidious occult bleeding can be a major problem
• Severity depends on bleeding origin
  • Venous
  • Capillary
  • Arterial
• Types of UGI bleeding
  • Obvious bleeding
    • Hematemesis
      • Bloody vomitus
      • Appears fresh, bright red blood or “coffee grounds”
    • Melena
      • Black, tarry stools
      • Caused by digestion of blood in GI tract
      • Black appearance—due to iron
  • Occult bleeding
    • Small amounts of blood in gastric secretions, vomitus, or stools
    • Undetectable by appearance
    • Detectable by guaiac test

Massive UGI Bleed

• Massive upper GI hemorrhage is defined as 1500 mL of blood
  • Of patients who have massive hemorrhage, 80% to 85% spontaneously stop bleeding
  • Cause still must be identified and treatment started immediately

Common Causes of UGI Bleeding

• Esophageal origin
  • Chronic esophagitis
    • GERD
    • Mucosa-irritating drugs
    • Smoking
    • Alcohol use
  • Mallory-Weiss tear
  • Esophageal varices
• Stomach and duodenal origin
  • Peptic ulcer disease
    • Bleeding ulcers account for 40% of cases of UGI bleeding
  • Drugs
    • Aspirin, NSAIDs, corticosteroids
  • Stress-related mucosal disease (SRMD)
    • Also called physiologic stress ulcers
    • Most common in critically ill patients
      • Severe burns, trauma, or major surgery
      • Patients with coagulopathy on mechanical ventilation
• Drug-induced origin
  • Corticosteroids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Salicylates
• Systemic disease origin
  • Blood dyscrasias (e.g., leukemia, aplastic anemia)
  • Renal failure