Curriculum · Gastroenterology
Upper gastrointestinal bleeding
What it is
Upper GI bleeding is bleeding proximal to the ligament of Treitz. The first split to make is variceal or non variceal.
Causes and risk
Four causes account for 80% of it: peptic ulcer disease, esophagogastric varices, esophagitis, and Mallory-Weiss tear. Peptic ulcer disease caused by H. pylori infection or NSAID use is the most common cause of nonvariceal bleeding. The wider list adds gastritis, AV malformation and the Dieulafoy lesion, which is an uncommon but important cause of massive, intermittent bleeding. Grouped as venous or arterial, the venous or variceal causes are cirrhosis, Budd-Chiari syndrome and splenic vein thrombosis, while the arterial or nonvariceal causes are peptic ulcer disease, Mallory-Weiss tear, hemorrhagic gastritis, neoplasm, inflammatory pseudoaneurysms, aortoduodenal fistula, iatrogenic injury, trauma, hemobilia and hemosuccus pancreaticus. Dual antiplatelet therapy with aspirin and clopidogrel, as given after PCI, increases the chance of a peptic ulcer bleed. One clinical profile of acute upper gastrointestinal bleeding from India gives the incidence of each cause as duodenal ulcer 43.9%, gastric ulcer 17.1%, erosive mucosal disease 11.7%, portal hypertension 10.8%, Mallory-Weiss syndrome 10.8%, reflux esophagitis 2.7%, and tumors and others 3.6%.