Yes, Erosive Gastritis Can Cause Melena
Erosive gastritis is a recognized cause of melena (black, tarry stools) and accounts for 8-15% of acute upper gastrointestinal bleeding cases. 1
Understanding the Mechanism
Melena occurs when blood from the upper gastrointestinal tract undergoes digestion by gastric acid and intestinal bacteria, producing the characteristic black, tarry appearance. Gastroduodenal erosions (which include erosive gastritis) are explicitly listed as a cause of upper GI bleeding that presents with melena in the British Society of Gastroenterology guidelines 1.
Clinical Evidence
Multiple case reports and clinical studies confirm this relationship:
A 2003 study of 49 consecutive patients with erosive gastroduodenitis found that all patients presented with hematemesis and/or melena, with the body of the stomach being the most common site of erosions (61%) 2
A 2002 case report documented a 22-year-old man with extensive hemorrhagic erosive gastritis who presented specifically with epigastralgia and melena 3
A 2022 case described sintilimab-induced acute erosive hemorrhagic gastritis presenting with epigastric pain and melena 4
A 1976 study of 100 consecutive upper GI bleeding cases found erosive gastritis was one of the top causes, with patients presenting with either hematemesis or melena 5
Clinical Significance
Patients presenting with melena alone typically have less severe bleeding than those with both hematemesis and melena (Grade C evidence) 1. However, erosive gastritis can still cause clinically significant blood loss requiring intervention.
The international consensus recommends using prognostic scales like the Blatchford score, which includes melena as a predictor variable, to stratify bleeding risk 6.
Common Associations
Erosive gastritis causing melena is frequently associated with:
- NSAID use (found in 80% of cases in one study) 2
- Alcohol ingestion 5
- Aspirin use 5
- Acute pancreatitis 3
- Immune checkpoint inhibitor therapy 4
Diagnostic Approach
When melena is present, esophagogastroduodenoscopy (EGD) is the primary diagnostic method to identify erosive gastritis as the bleeding source 7, 8. The upper gastrointestinal tract is the most common source of melena in both adults and children 7.