Common Causes of Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding refers to bleeding that occurs in the digestive tract above the Treitz ligament, including the esophagus, stomach, duodenum, or lesions in the pancreobiliary region. Bleeding caused by lesions in the jejunum after gastrojejunostomy also falls under this category.

Primary Causes of Upper GI Bleeding

There are numerous potential causes of upper gastrointestinal bleeding, but the most common include peptic ulcers, acute gastric mucosal lesions, esophageal and gastric varices, and gastric cancer. Each of these conditions presents with distinct symptoms and risk factors, and understanding them is essential for accurate diagnosis and treatment.

Peptic Ulcers

Patients with peptic ulcers often have a history of upper abdominal pain. This pain is typically chronic, cyclical, and rhythmic in nature. It may intensify before a bleeding episode and often subsides after bleeding occurs. Peptic ulcer disease is a major contributor to upper GI bleeding and can be diagnosed through endoscopic evaluation.

Acute Gastric Mucosal Lesions

Acute gastric mucosal injury is another common cause of upper GI bleeding. This condition often occurs in individuals who have taken nonsteroidal anti-inflammatory drugs (NSAIDs), consumed excessive alcohol, or experienced severe physiological stress. Patients may have a history of gastric mucosal damage, and timely medical intervention is crucial to prevent complications.

Esophageal and Gastric Varices

Bleeding from esophageal or gastric varices is particularly dangerous and often presents with massive hematemesis (vomiting blood) and melena (black tarry stools). Patients with this condition typically have a history of chronic viral hepatitis or long-term alcohol abuse. Clinical signs of liver dysfunction and portal hypertension, such as splenomegaly and ascites, are commonly observed. Immediate medical attention is essential due to the high mortality risk associated with variceal rupture.

Gastric Cancer

Gastric cancer is more prevalent among middle-aged and older adults. Symptoms may include epigastric pain, a feeling of fullness, loss of appetite, and unexplained weight loss. Early diagnosis is critical, and endoscopy combined with biopsy is often required to confirm the presence of malignancy.

Diagnostic Approaches

In all of the above cases, upper gastrointestinal endoscopy is the primary diagnostic tool. It allows for direct visualization of the bleeding source and facilitates targeted interventions. In certain situations, histopathological examination may be necessary to confirm the diagnosis, especially when malignancy or chronic inflammation is suspected.