Upper gastrointestinal bleeding, its symptoms and causes
Upper gastrointestinal (GI) bleeding usually represents a bleeding in the gastrointestinal tract above the ligament of Treitz (meaning of ligament). Upper GI bleeding could manifest as vomiting of fresh blood or coffee ground material or medically termed as hematemesis or it could present with passage of black tarry foul smelling stools or medically termed as melena. GI bleeding could eventually lead to anemia if left untreated and patients could present with dizziness, light-headedness, syncope and chest pain. It is important when dealing with GI bleeding to know the cause/source of bleeding to be able to give the appropriate therapy.
Causes of Upper GI Bleeding
Gastro and Duodenal Ulcers – this is the most common cause of upper GI bleeding worldwide. Ulcerations within the walls of the stomach and duodenum occur when the defence mechanism of the stomach is overpowered by the acid secreted by it. It could also be seen among patients taking Aspirin and other Non-steroidal anti-inflammatory drugs. An ulcer usually present with epigastric pain often described as burning in character and is usually relieved by eating food and aggravated by fasting. These ulcers will lead to bleeding if left untreated.
Esophageal Varices – esophageal varices are usually seen among liver cirrhotic patients with portal vein hypertension. As the pressure in the portal vein increases, these varices will eventually increase in size and the chance of rupture increases. Morbidity and mortality are usually high if a variceal rupture will occur. Liver cirrhotic patients should be assess for the presence of esophageal varices.
Mallory-Weiss Tear – is a tear in the gastroesophageal junction usually cause by severe vomiting or retching. Patients would present with hematemesis (vomiting of fresh blood), and some with lacerating pain in the chest. Treatment should be given promptly as to avoid hypovolemic shock. Alcoholics who have severe vomiting or retching after a drinking binge could acquire this injury.
Erosive Gastritis – are erosions in the stomach usually seen by endoscopy. They produce Upper GI bleeding but are not usually massive unless ulceration will occur. Common factors causing of erosions usually include NSAID intake, persistent alcohol intake, and stress. Same as ulceration, it could present with epigastric pain and burning in character. Limit of NSAID intake and lifestyle modifications can decrease the occurrence of erosive gastritis.
Neoplasm – although not that common, a neoplasm or a mass in the stomach or in the duodenum could present with upper GI bleeding. Prompt investigation should be done to localize the lesion and determine the type of neoplasm.
Vascular lesions – some vascular lesions in the stomach and duodenum could present with upper GI bleeding although it is not that common.
In dealing with upper gastrointestinal (GI) bleeding, a prompt investigation should be initiated to determine the cause to be able to stop the bleeding. Blood transfusions are usually indicated for patients who have massive upper GI bleeding. Advancements in gastroenterology have decrease the morbidity and mortality in patients presenting with upper GI bleeding. Remember the symptoms and seek physician consult right away.