Upper Gastrointestinal Bleeding: Understanding the Affected Areas

Upper gastrointestinal bleeding refers to hemorrhage that occurs in the upper part of the digestive tract, specifically above the Treitz ligament. This includes bleeding from the esophagus, stomach, duodenum, bile ducts, and pancreas. Common causes of upper gastrointestinal bleeding include peptic ulcers such as gastric ulcers, duodenal ulcers, and anastomotic ulcers. Additionally, conditions like portal hypertensive gastropathy and esophageal or gastric varices, often associated with liver cirrhosis and portal hypertension, can also lead to significant bleeding.

Causes of Upper Gastrointestinal Bleeding

Acute Erosive Hemorrhagic Gastritis

One of the more common causes is acute erosive hemorrhagic gastritis, which can result from the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and acetaminophen. Alcohol consumption can also cause acute damage to the gastric mucosa. Moreover, physical stressors like surgery, trauma, severe infections, and cerebrovascular diseases can lead to stress-induced mucosal damage, resulting in this type of gastritis.

Gastrointestinal Tumors

Another significant cause is gastrointestinal malignancies, including gastric cancer, gastrointestinal stromal tumors (GISTs), and esophageal cancer. These tumors can erode blood vessels in the upper digestive tract, leading to bleeding. Although less common, other causes include biliary tract hemorrhage due to injury, inflammation, or tumors affecting the bile ducts.

Other Contributing Factors

Pancreatic injuries, such as a ruptured pancreatic abscess, and esophageal-gastric mucosal tears, like those seen in Mallory-Weiss syndrome, are also recognized causes of upper gastrointestinal bleeding. These conditions can occur following episodes of severe vomiting or retching and should be considered in patients presenting with hematemesis or melena.