Common Causes of Upper Gastrointestinal Bleeding

Upper gastrointestinal (GI) bleeding can result from various medical conditions, some of which are more prevalent than others. Understanding these causes is essential for timely diagnosis and treatment. The most common factors contributing to upper GI bleeding include the following:

Digestive Ulcers

Digestive ulcers, such as gastric ulcers and duodenal ulcers, are among the leading causes of upper GI bleeding. These ulcers occur when the protective lining of the stomach or duodenum is eroded, exposing underlying blood vessels that may rupture and cause bleeding.

Acute Hemorrhagic Erosive Gastritis

Another frequent cause is acute hemorrhagic erosive gastritis, often linked to long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or excessive alcohol consumption. This condition leads to inflammation and erosion of the stomach lining, which can result in bleeding.

Gastrointestinal Tumors

Tumors in the stomach, duodenum, or esophagus—including gastric cancer and esophageal cancer—can also lead to upper GI bleeding. These growths may erode blood vessels or create ulcers, both of which can cause significant blood loss.

Other Contributing Factors

Additional causes include esophageal varices, which are enlarged veins in the esophagus or stomach caused by portal hypertension, often due to severe liver disease. These veins can rupture and cause life-threatening bleeding. Another condition, Mallory-Weiss syndrome, involves tears in the esophagus or gastroesophageal junction, typically caused by severe vomiting or retching. Rarely, bleeding may originate from the biliary tract due to trauma, inflammation, or tumors.

Symptoms and Clinical Presentation

After an upper GI bleed occurs, patients may experience symptoms such as vomiting blood (hematemesis) and black, tarry stools (melena). If the bleeding is substantial and rapid, the patient may vomit bright red blood or dark clots. In cases where blood remains in the GI tract for a longer period, it undergoes chemical changes due to stomach acid, turning into a coffee-ground appearance.

Understanding Melena

Melena occurs when iron in the blood reacts with gastric acid and enzymes like pepsin, converting it into ferrous iron. This then combines with sulfur compounds in the intestines to form ferrous sulfide, resulting in dark-colored stools. These stools are typically loose, unformed, and have a distinctive tarry consistency.