Upper Gastrointestinal Bleeding: Common Causes and Risk Factors
Upper gastrointestinal (GI) bleeding is a serious medical condition that occurs when there is damage or rupture in the upper digestive tract, including the esophagus, stomach, and duodenum. Clinically, the most common causes of upper GI bleeding are peptic ulcers, ruptured esophagogastric varices, acute erosive hemorrhagic gastritis, and gastric cancer. Individuals with liver cirrhosis or a history of peptic ulcer disease are particularly at risk. Consuming hard or irritating foods can also trigger episodes of bleeding.
Primary Causes of Upper GI Bleeding
1. Esophageal Conditions
Esophageal disorders such as esophagitis, esophageal ulcers, esophageal tumors, Mallory-Weiss syndrome (a tear in the mucous membrane at the junction of the esophagus and stomach), and physical or chemical injuries can all lead to upper GI bleeding. These conditions often result from chronic acid reflux, excessive alcohol consumption, or ingestion of corrosive substances.
2. Gastric and Duodenal Diseases
Several gastric and duodenal conditions are known to cause upper GI bleeding. These include peptic ulcers, ruptured esophagogastric varices, portal hypertensive gastropathy, acute hemorrhagic erosive gastritis, gastric vascular malformations (such as arteriovenous malformations), gastric cancer, other gastric tumors, acute gastric dilation, duodenitis, diverticulitis, diaphragmatic hernia, gastric volvulus, hookworm infestation, and ulcers following gastrointestinal anastomotic surgery.
3. Liver and Gallbladder Disorders
Conditions affecting the liver and gallbladder can also lead to upper GI bleeding. These include localized chronic infections within the liver, liver abscesses, hepatocellular carcinoma, ruptured hepatic hemangiomas, central liver lacerations due to trauma, and damage to the biliary tract. These issues often result in hemobilia, or bleeding into the biliary system.
4. Adjacent Organ Involvement
Bleeding can also occur when diseases of nearby organs or tissues affect the upper GI tract. Examples include pancreatic diseases that extend into the duodenum, thoracic or abdominal aortic aneurysms that rupture into the digestive tract, and mediastinal tumors or abscesses that erode into the esophagus.
5. Systemic Diseases
Systemic conditions can contribute to upper GI bleeding as well. Blood disorders such as leukemia, aplastic anemia, and hemophilia, as well as connective tissue diseases and vasculitis, may impair normal clotting mechanisms. Stress-related mucosal injury, often seen in critically ill patients, can also lead to bleeding. Additionally, acute infectious diseases like epidemic hemorrhagic fever, leptospirosis, and uremia can cause gastrointestinal bleeding.
Common Triggers of Upper GI Bleeding
1. Acute Stress Events
Severe trauma, major surgery, critical illness, or intense psychological stress can trigger stress-induced gastritis. This condition causes varying degrees of gastric mucosal erosion, superficial ulcers, and bleeding, especially in hospitalized or ICU patients.
2. Medication Use
Certain medications are known to increase the risk of upper GI bleeding. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, antiplatelet agents such as clopidogrel, corticosteroids, chemotherapy drugs, and certain antibiotics. These medications can damage the protective lining of the stomach and reduce the body's ability to form clots.
3. Dietary Factors
Consuming hard or irritating foods can physically damage blood vessels in the digestive tract. Examples include nuts, fried foods, and alcohol, which can directly rupture varices. Spicy foods, strong tea, coffee, and acidic beverages may also irritate the gastric lining and lead to mucosal injury through various physiological mechanisms.
4. Increased Abdominal Pressure
Activities or conditions that increase intra-abdominal pressure—such as heavy lifting, chronic coughing, or straining during bowel movements—can exacerbate portal hypertension. This, in turn, increases the risk of variceal rupture and bleeding, especially in patients with underlying liver disease.