Treatment Options for Non-Variceal Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding can have various causes, and once esophageal or gastric varices have been ruled out through endoscopy, other potential sources must be considered. The most common non-variceal causes include peptic ulcer disease, acute gastritis or gastric mucosal lesions, Mallory-Weiss tears, and in some cases, gastric malignancies.

Peptic Ulcer Disease and Gastric Mucosal Lesions

Peptic ulcers and acute gastric mucosal injuries are often linked to excessive gastric acid production and conditions that increase gastric stress, such as severe illness or prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs). These conditions can lead to erosion of the stomach lining and subsequent bleeding.

The primary treatment strategy involves reducing gastric acidity and promoting mucosal healing. Proton pump inhibitors (PPIs) such as omeprazole or lansoprazole are typically administered intravenously to effectively suppress acid secretion. Additionally, intravenous administration of somatostatin or its analog octreotide may be used to decrease splanchnic blood flow and reduce the risk of rebleeding.

Mallory-Weiss Syndrome

Mallory-Weiss syndrome refers to tears in the mucosa at the gastroesophageal junction, usually caused by severe vomiting or retching. These tears can lead to significant bleeding and require prompt medical attention.

Management of Mallory-Weiss tears typically involves a period of fasting to allow the mucosa to heal. Intravenous fluids are provided to maintain hydration, and medications such as antispasmodics or proton pump inhibitors may be used to reduce gastric irritation and promote healing. In most cases, the tear heals within a few days without the need for invasive intervention.

Gastric Cancer as a Cause of Bleeding

Diagnostic and Therapeutic Considerations

When gastric cancer is identified as the source of bleeding, further diagnostic testing is essential. This includes imaging studies and possibly endoscopic ultrasound to assess the extent of the disease and determine whether the tumor is resectable.

Treatment options depend on the stage and overall health of the patient. Surgical resection remains the primary curative approach for localized disease. For advanced or metastatic cases, systemic therapy such as chemotherapy or targeted therapy may be recommended. Palliative endoscopic interventions or radiation therapy can also be considered to control bleeding and improve quality of life.

Conclusion

Non-variceal upper gastrointestinal bleeding requires a tailored approach based on the underlying cause. Prompt diagnosis through endoscopy and appropriate medical or surgical management are crucial to preventing complications and improving patient outcomes. Whether due to ulcers, mucosal injury, or malignancy, each case demands a comprehensive evaluation and individualized treatment plan.