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

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