Most Common Causes of Upper GI Bleeding
Peptic ulcer disease is the most common cause of upper gastrointestinal bleeding, accounting for 35-50% of cases, followed by Mallory-Weiss syndrome (15%), gastroduodenal erosions (8-15%), esophagitis (5-15%), and esophageal varices (5-10%). 1
Frequency of Upper GI Bleeding Causes
The American Gastroenterological Association identifies the following as the most common etiologies of upper GI bleeding:
- Peptic ulcer disease: 35-50%
- Mallory-Weiss syndrome: 15%
- Gastroduodenal erosions: 8-15%
- Esophagitis: 5-15%
- Esophageal varices: 5-10%
- Vascular malformations: 1%
- Dieulafoy lesion: 1-2% 1
Less Common Causes
Several less common but clinically significant causes of upper GI bleeding include:
- Neoplasms (gastric or esophageal cancer)
- Hemobilia
- Hemosuccus pancreaticus (1 in 500 cases)
- Aortoenteric fistula (rare but potentially catastrophic)
- Iatrogenic causes (post-endoscopic procedures, complications from biliary stenting) 1
Regional Variations in Etiology
It's important to note that the etiology of upper GI bleeding can vary significantly by geographic region:
- In the United States and Western countries, peptic ulcer disease is the predominant cause (approximately 50% of cases) 2
- In tropical countries like India, esophageal varices may account for up to half of the cases 3, 4
Clinical Presentation
The primary signs of upper GI bleeding include:
- Hematemesis (vomiting of blood or coffee-ground material)
- Melena (black, tarry stools) - typically requires at least 50-100 mL of blood 1
- Patients presenting with both hematemesis and melena typically have more severe bleeding 1
Risk Factors
Several factors increase the risk of upper GI bleeding:
- Advanced age
- Prior history of upper GI bleeding
- Anticoagulant use
- High-dose NSAID use
- H. pylori infection
- Alcohol consumption
- Smoking
- Pre-existing liver disease 1
Clinical Implications
Understanding the etiology of upper GI bleeding is crucial for management:
- Upper GI bleeding ceases spontaneously in approximately 75-85% of cases
- Mortality remains significant (up to 14% in some studies)
- Endoscopic intervention is required for active bleeding or signs of recent bleeding that hasn't stopped spontaneously 1
Diagnostic Approach
Upper endoscopy remains the gold standard for diagnosis:
- Should be performed within 24 hours of presentation, after adequate resuscitation
- Has a diagnostic yield of up to 95%
- Serves both diagnostic and therapeutic purposes 1
The distribution of causes may vary based on patient demographics, geographic location, and underlying comorbidities, highlighting the importance of prompt endoscopic evaluation in patients presenting with upper GI bleeding.