Can Gastritis Cause Upper GI Bleeding?
Yes, gastritis can cause upper gastrointestinal bleeding, though it is a relatively uncommon source of acute hemorrhage and accounts for approximately 8-15% of upper GI bleeding cases. 1
Epidemiology and Clinical Significance
Gastroduodenal erosions (including gastritis) represent 8-15% of acute upper GI bleeding cases, making them less common than peptic ulcer disease (35-50%) but still clinically significant 1
Hemorrhagic gastritis specifically accounts for approximately one-fourth of upper GI bleeding in endoscopic studies, though this represents a broader category that includes acute erosive disease 2
The American College of Radiology recognizes gastric erosions and stress-related mucosal disease as prevalent causes in critically ill ICU patients, particularly those with risk factors such as mechanical ventilation, coagulopathy, and renal failure 3
Important Clinical Context and Controversy
There is notable controversy regarding gastritis as a bleeding source. While commonly reported in endoscopic series, one critical study suggests that gastritis, though a relatively common endoscopic finding, is rarely the actual source of acute upper gastrointestinal bleeding 4. This highlights a key clinical pitfall: the presence of gastritis on endoscopy does not automatically mean it is the bleeding source.
Predisposing Conditions
When gastritis does cause bleeding, it typically occurs in patients with specific risk factors 2:
- Alcohol abuse
- Portal hypertension
- Short- or long-term NSAID use
- Physiologic stress associated with ICU hospitalization for severe life-threatening disease or trauma
Clinical Presentation Spectrum
The clinical course varies dramatically from mild, self-limited illness when associated with gastric irritants, to life-threatening massive hemorrhage when associated with stress in critically ill patients 5
Patients may present with hematemesis, coffee-ground emesis, melena, or even hematochezia if bleeding is massive 1
Diagnostic Approach
Upper endoscopy (EGD) is the first-line diagnostic approach for suspected upper GI bleeding, as recommended by the American College of Radiology 6
Endoscopy should be performed within 24 hours of presentation once hemodynamic stability is achieved 3
Cameron's erosions in large hiatal hernias and gastric antral vascular ectasia are commonly overlooked gastritis-related lesions during initial workup 1
Management Principles
Treatment parallels that of classic peptic ulcer disease, focusing on supportive measures and therapies directed toward healing mucosal damage 2
Proton pump inhibitors should be initiated upon presentation with upper GI bleeding 7
High-dose PPI treatment is recommended for the first 72 hours post-endoscopy because this is when rebleeding risk is highest 7
Withdrawal of offending gastric irritants (NSAIDs, alcohol), intensive organ system support, and reduction of gastric acidity form the cornerstone of management 5
Key Clinical Pitfall
The major challenge with hemorrhagic gastritis is the potential for diffuse mucosal bleeding, which makes endoscopic hemostatic therapy more difficult compared to focal lesions like peptic ulcers 2. Surgery remains an option of last resort for patients who continue to bleed despite aggressive medical and endoscopic therapy 2.