Diagnosing Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding is primarily diagnosed based on medical history, symptoms, and clinical examinations. The following diagnostic tests are commonly used to confirm the condition and identify its cause:

Laboratory Tests

Blood tests including platelet count, coagulation time, complete blood count (CBC), prothrombin time, and blood ammonia levels are essential. These tests help distinguish bleeding caused by esophageal varices due to liver cirrhosis from other potential causes. They also provide insights into the patient's overall blood status and clotting ability.

Swallowed Thread Test or Fluorescein Swallowed Thread Test

This simple yet effective procedure involves using a thread that the patient swallows. The thread may become stained or marked by the presence of blood in the digestive tract, allowing doctors to estimate the location of the bleeding source based on where the discoloration occurs.

Radioisotope Imaging

Radioactive nuclear imaging is particularly useful in detecting active gastrointestinal bleeding. This non-invasive method can identify even minor bleeding that may not be immediately visible through other diagnostic tools.

Selective Angiography

Selective arterial angiography is a more advanced diagnostic technique that can pinpoint the exact site of bleeding. It is especially effective in diagnosing hemorrhages caused by vascular malformations, aneurysms, arteriovenous fistulas, or abnormal blood vessel structures. This method is often used in emergency cases where endoscopy has not provided a clear diagnosis and the bleeding continues.

Endoscopic Examination

Endoscopy remains one of the most valuable tools for diagnosing upper GI bleeding. It allows direct visualization of the upper gastrointestinal tract, enabling doctors to identify the exact location and nature of the lesion causing the bleed. In many cases, treatment can also be administered during the same procedure.

Barium X-ray and Double-contrast Barium Study

While less commonly used today, barium studies such as the barium meal and double-contrast imaging can still play a supportive role in diagnosis. These imaging techniques enhance the visibility of the gastrointestinal lining and can help detect abnormalities that may be contributing to the bleeding.