Upper gastro-intestinal bleeding

Upper gastro-intestinal bleeding refers to a digestive bleeding that occurs upstream of the small intestine (the angle of Treitz). Patients experience bloody vomiting, named hematemesis, and/or black stools containing digested blood, named melena.

The main causes of upper gastro-intestinal bleeding are ulcers in the stomach and in the duodenum . These are usually caused/provoked by the consumption of anti-inflammatory drugs (NSAID), hyper-acid secretion, stress, infection with the bacterium Helicobacter pylori , lesions of the esophagus (caused for example by gastroesophageal reflux disease or by efforts to vomit (Mallory-Weiss syndrome) or of the stomach (for example Cameron's ulcer in patients with Hiatal hernia ), esophageal varices in patients with liver cirrhosis, vascular lesions (angiodysplasia, Dieulafoy lesion) or cancer.

Assessment of upper gastro-intestinal bleeding

The initial assessment for upper gastro-intestinal bleeding is the same as for any hemorrhage. It includes a medical examination, blood tests, as well as hemodynamic stabilization. This may require blood transfusion, placement of a nasogastric tube and administration of drugs that inhibit acid secretion from the stomach. In case of the presence of liver cirrhosis , antibiotics and drugs to lower the blood pressure in esophageal varices are also administered.

A gastroscopy is then realized in order to identify and to control the origin of the bleeding. In case the source of the bleeding is not identified, a colonoscopy is performed and is sometimes associated to other examinations.

The treatment of upper gastro-intestinal bleeding depends on its cause and is very rarely surgical.