Causes of Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding refers to bleeding that occurs in areas above the Treitz ligament of the duodenum, including the esophagus, stomach, duodenum, biliary tract, and pancreas. There are several common causes of this condition, which can be categorized into different groups.

1. Esophageal Conditions

One of the primary causes of upper GI bleeding is related to disorders of the esophagus. These include esophageal and gastroesophageal mucosal tears, inflammation of the esophagus, mechanical injury to the esophageal mucosal vessels, chemical damage from ingested substances, and rare cases such as a ruptured aortic aneurysm that affects the esophagus.

2. Gastric and Duodenal Diseases

Conditions affecting the stomach and duodenum are also significant contributors to upper gastrointestinal bleeding. These may include gastritis, peptic ulcers, benign or malignant tumors, polyps, and congenital vascular malformations. Ulcers, in particular, are a common cause and can be triggered by Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

3. Biliary and Pancreatic Disorders

Certain diseases of the biliary system and pancreas can also lead to upper GI bleeding. These include conditions such as biliary ascariasis (intestinal worms in the biliary tract), bile duct stones, bile duct tumors, and pancreatic cancers. These disorders can erode blood vessels or obstruct normal digestive pathways, leading to bleeding complications.

4. Systemic Diseases

Systemic illnesses that affect the body's ability to regulate blood clotting or maintain vascular integrity can also result in gastrointestinal bleeding. Examples include hematologic disorders like leukemia, immune-related conditions such as Henoch-Schönlein purpura (allergic purpura), and disseminated intravascular coagulation (DIC), which disrupts normal blood clotting mechanisms.

5. Liver Cirrhosis and Related Complications

One of the most serious and potentially life-threatening causes of upper GI bleeding is associated with liver cirrhosis. This condition leads to portal hypertension, which can cause dilated veins in the esophagus and stomach (varices). When these veins rupture, they can cause massive and rapid blood loss. Portal hypertensive gastropathy is another complication that can contribute to bleeding in patients with advanced liver disease.