What are the causes of acute hematemesis (vomiting blood)?

From the Guidelines

Acute hematemesis requires immediate medical attention and stabilization with two large-bore IV lines, fluid resuscitation, and blood transfusion if necessary, as indicated by the most recent guidelines 1. The initial management of acute hematemesis involves assessing the severity of bleeding and stabilizing the patient.

• Establishing two large-bore IV lines (16-18 gauge) for fluid resuscitation and potential blood transfusion is crucial.
• Fluid resuscitation with crystalloids should be initiated to achieve a fall in pulse rate, rising blood pressure, central venous pressure, and adequate urine output, as suggested by 1.
• Blood transfusion is necessary if the hemoglobin concentration is less than 100 g/l or if the patient is hemodynamically unstable, as recommended by 1.
• Proton pump inhibitors, such as pantoprazole 80 mg bolus followed by 8 mg/hour infusion for 72 hours, should be administered intravenously to reduce gastric acid secretion.
• Urgent endoscopy within 24 hours is essential for diagnosis and potential therapeutic intervention, as stated by 1.
• The severity of bleeding can be assessed using scoring systems like the Glasgow-Blatchford score to guide management decisions.
• Hematemesis can result from various causes, including peptic ulcers, gastritis, esophageal varices, or Mallory-Weiss tears, with management tailored to the underlying etiology identified during endoscopy, as reported by 1 and 1. The most common etiologies of upper gastrointestinal bleeding are duodenal ulcer, gastric erosions, gastric ulcer, varices, Mallory-Weiss tears, esophagitis, duodenitis, and neoplasm, as identified by 1.
• Patients with suspected variceal bleeding should be treated with terlipressin 2 mg IV every 4 hours or octreotide 50 mcg bolus followed by 50 mcg/hour infusion, along with prophylactic antibiotics like ceftriaxone 1g daily.
• Coagulopathy should be corrected with fresh frozen plasma or vitamin K as needed, and patients should be kept nil by mouth until endoscopy is performed. Overall, the management of acute hematemesis should prioritize stabilization, diagnosis, and treatment of the underlying cause, with a focus on reducing morbidity, mortality, and improving quality of life, as emphasized by the most recent and highest quality study 1.

From the Research

Definition and Causes of Acute Hematemesis

• Acute hematemesis refers to the sudden onset of vomiting blood, which can be a life-threatening condition [ 2 ].
• The causes of hematemesis include peptic ulcers, oesophageal varices, and other gastrointestinal disorders [ 2 ].

Treatment of Acute Hematemesis

• The treatment of hematemesis involves resuscitation of the patient and addressing the underlying cause of the bleeding [ 2 ].
• Proton pump inhibitors (PPIs) such as pantoprazole and omeprazole are commonly used to decrease the rate of rebleeding in patients with bleeding peptic ulcers [ 3 , 4 ].
• The choice of PPI and the route of administration (intravenous or oral) may depend on the severity of the bleeding and the patient's condition [ 3 , 4 ].

Eradication of Helicobacter pylori

• Helicobacter pylori infection is a common cause of peptic ulcers, and eradication of the infection is an important part of the treatment [ 5 , 6 ].
• Triple therapy with a PPI, amoxicillin, and clarithromycin is a commonly used regimen for eradicating H. pylori infection [ 5 , 6 ].
• The duration of treatment may vary, but a 7-day course of triple therapy has been shown to be effective in eradicating H. pylori infection [ 6 ].