What are the signs of an upper Gastrointestinal (GI) bleed?

From the Guidelines

Upper gastrointestinal (GI) bleeding typically presents with signs such as hematemesis, melena, or hematochezia, and patients may experience symptoms like lightheadedness, dizziness, or confusion due to blood loss and reduced blood pressure. The most obvious sign is hematemesis, which is vomiting of bright red blood or coffee-ground material (partially digested blood) 1. Melena, black tarry stools with a distinctive odor, indicates blood that has been digested as it passes through the intestines. Hematochezia, bright red blood from the rectum, may occur with massive upper GI bleeding. Patients often experience symptoms like lightheadedness, dizziness, syncope, or confusion due to blood loss and reduced blood pressure. Physical examination may reveal tachycardia, hypotension, pallor, and cool extremities, indicating hemodynamic compromise. Laboratory findings typically show decreased hemoglobin and hematocrit levels.

Common Causes of Upper GI Bleeding

• Peptic ulcers
• Gastritis
• Esophageal varices
• Mallory-Weiss tears
• Malignancies

Key Diagnostic Techniques

• Upper endoscopy
• Video capsule endoscopy (VCE) The severity of these signs correlates with the volume and rate of blood loss, with rapid bleeding potentially leading to hypovolemic shock. Any patient presenting with these signs should receive immediate medical evaluation, as prompt diagnosis and treatment significantly improve outcomes in upper GI bleeding 1.

From the Research

Signs of an Upper GI Bleed

• Hematemesis (vomiting blood) is the most frequent presentation of upper gastrointestinal bleeding (UGIB) 2
• Other signs and symptoms may include:
  • Abdominal pain
  • Lightheadedness
  • Dizziness
  • Syncope (fainting)
  • Melena (black, tarry stools) 3
• Physical examination may reveal:
  • Hemodynamic instability
  • Abdominal pain or rebound tenderness
  • Examination of stool color 3
• Laboratory tests may include:
  • Complete blood count
  • Basic metabolic panel
  • Coagulation panel
  • Liver tests
  • Type and crossmatch 3

Classification of Upper GI Bleed

• Upper GI bleeding can be classified into two categories:
  • Variceal bleeding
  • Non-variceal bleeding 4, 3
• Variceal bleeding is often more severe and may require earlier endoscopy and intervention 2, 5
• Non-variceal bleeding may be caused by peptic ulcer disease, gastritis, esophagitis, or other conditions 3

Risk Stratification

• Clinical prediction guides, such as the Glasgow-Blatchford bleeding score, can be used to stratify patients with upper GI bleeding into high- and low-risk categories 2, 3
• Patients with hemodynamic instability and signs of upper GI bleeding should be offered urgent endoscopy 3, 5