From the Guidelines
Peptic ulcer disease is the most common cause of upper gastrointestinal (GI) bleeding, accounting for the majority of nonvariceal UGIB cases. This condition is often caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drug use, as stated in the 2024 update of the ACR Appropriateness Criteria for nonvariceal upper gastrointestinal bleeding 1. The incidence of nonvariceal UGIB is significantly higher than that of variceal UGIB, with peptic ulcer disease being the leading cause. Other causes of nonvariceal UGIB include Mallory-Weiss tears, esophagitis, pancreatitis, trauma, iatrogenic, or neoplastic conditions, but these are less common.
Some key points to consider in the management of upper GI bleeding include:
- The initial management focuses on resuscitation, maintenance of hemodynamic stability, and triage 1
- Esophagogastroduodenoscopy is the usual first-line diagnostic and therapeutic investigation, as recommended by the American College of Gastroenterology practice guidelines and an American Gastroenterological Association expert statement 1
- The risk of rebleeding, massive hemorrhage, and death is high, even though 80% to 85% of cases of UGIB cease spontaneously 1
- Video capsule endoscopy may be used in certain cases, especially if the bleeding site is suspected to be below the ligament of Treitz 1
The primary factors contributing to peptic ulcer formation, which is the most common cause of upper GI bleeding, include Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) 1. Management typically involves stabilizing the patient hemodynamically, identifying the bleeding source through endoscopy, and providing appropriate treatment such as proton pump inhibitors, endoscopic therapy, and addressing underlying causes such as H. pylori eradication or discontinuation of NSAIDs when possible.
From the Research
Causes of Upper Gastrointestinal (GI) Bleeding
- The most common cause of upper GI bleeding is peptic ulcer disease, which is largely associated with the intake of NSAIDs and Helicobacter pylori infection 2, 3, 4, 5
- Other causes of upper GI bleeding include esophageal and gastric varices, gastroduodenal erosions, Mallory Weiss tears, angiodysplasia, and gastric antral vascular ectasia (GAVE)-Watermelon stomach 4, 6
- Risk factors for upper GI bleeding include prior upper GI bleeding, anticoagulant use, high-dose nonsteroidal anti-inflammatory drug use, and older age 6
Diagnosis and Treatment
- Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage 2, 6
- Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality, and the number of emergency surgical interventions 2
- Clinical prediction guides, such as the Glasgow-Blatchford bleeding score, are necessary for upper GI bleeding risk stratification and to determine therapy 6
- Laparoscopic oversewing under endoscopic guidance is a possible early option to halt recurrent bleeding from peptic ulcers 5