Can methamphetamine use cause gastric bleeding?

Can Methamphetamine Cause Gastric Bleeding?

Yes, methamphetamine can cause gastric bleeding through its vasoconstrictive effects leading to gastrointestinal ischemia, which manifests as ulcerations, necrosis, and hemorrhage throughout the GI tract, including the stomach.

Mechanism of Gastrointestinal Injury

Methamphetamine produces a hyperadrenergic state by blocking neuronal reuptake of norepinephrine and dopamine, leading to profound vasoconstriction 1. This vasoconstrictive effect extends beyond the cardiovascular system to affect mesenteric and gastric blood flow, resulting in:

• Ischemic injury to the gastric mucosa that can progress to ulceration and bleeding 2
• Diffuse gastrointestinal ischemia affecting multiple segments from esophagus to colon 2, 3
• Nonocclusive mesenteric ischemia (NOMI) due to microvascular compromise without large vessel occlusion 4

Clinical Presentation and Evidence

The most compelling recent evidence comes from a 2025 case report documenting a patient with methamphetamine use who presented with hematemesis and was found on endoscopy to have diffuse ulcerations in the distal esophagus and post-pyloric region, with pathology confirming methamphetamine-induced gastrointestinal ischemia 2. This demonstrates that gastric bleeding is a documented complication of methamphetamine use.

Additional case series have documented:

• Fatal small intestinal ischemia with gangrene and perforation following methamphetamine toxicity 3
• Segmental gangrene of small bowel and colon requiring emergency surgical resection 5
• Perforated duodenal ulcers in patients with methamphetamine use 4
• Patchy necrosis throughout the entire GI tract in severe cases 4

High-Risk Clinical Scenarios

Methamphetamine-induced GI ischemia carries particularly high morbidity and mortality 2, 3. Be especially vigilant in:

• Patients presenting with abdominal pain and hematemesis who have known or suspected methamphetamine use 2
• Those using "diet pills" or weight-loss supplements that may contain undisclosed methamphetamine 3
• Rectal administration ("plugging") which bypasses first-pass metabolism and increases risk of severe toxicity and mesenteric ischemia 6
• Patients with dehydration or receiving vasoconstrictors, which may exacerbate intestinal ischemia 4

Critical Diagnostic Considerations

When evaluating patients with suspected methamphetamine-related GI bleeding:

• Obtain urine toxicology to confirm amphetamine presence 2
• Perform CT imaging to assess for bowel wall thickening, ischemia, or perforation 2, 3
• Consider early endoscopy to visualize mucosal injury and ulcerations 2
• Monitor for progression as ischemia can evolve from focal ulceration to transmural necrosis requiring surgical intervention 3, 5, 4

Common Pitfalls

The primary pitfall is failing to consider methamphetamine-induced ischemia in patients with stimulant use disorders presenting with acute abdominal symptoms 2, 5. A 2018 case series found that 6 of 10 patients with methamphetamine-associated NOMI died, with three deaths occurring within one week of admission 4. This underscores the importance of:

• Maintaining high clinical suspicion in areas with high methamphetamine prevalence 4
• Avoiding pure beta-blockers in acute methamphetamine intoxication, as they may worsen vasospasm through unopposed alpha-adrenergic stimulation 7
• Recognizing that patients admitted for other conditions may develop ischemia if they have ongoing methamphetamine use 4