What is the most common cause of upper Gastrointestinal (GI) bleeding: Esophageal varices, Gastritis, Mallory-Weiss tear, or Peptic Ulcer Disease (PUD)?

From the Guidelines

Peptic ulcer disease is the most common cause of upper GI bleeding, accounting for approximately 50-70% of cases, as it is the leading cause of nonvariceal upper GI bleeding 1. This condition occurs when stomach acid erodes the lining of the stomach or duodenum, creating ulcers that can bleed when they damage underlying blood vessels. The high prevalence of peptic ulcer disease as a cause of upper GI bleeding relates to the widespread use of NSAIDs, H. pylori infection, and other factors that contribute to the breakdown of the gastric mucosal barrier. Other causes of upper GI bleeding, such as esophageal varices, gastritis, and Mallory-Weiss tears, are less common, with varices accounting for about 10-20% of cases, gastritis causing about 20% of upper GI bleeds, and Mallory-Weiss tears representing only about 5-10% of cases 1. The most recent evidence suggests that peptic ulcer disease is the most common cause of nonvariceal upper GI bleeding, with an incidence of approximately 61 to 78 cases per 100,000 persons in the United States 1. Key points to consider in the management of upper GI bleeding include:

• Resuscitation and maintenance of hemodynamic stability
• Identification of the source of bleeding and bleeding control
• Use of esophagogastroduodenoscopy as the usual first-line diagnostic and therapeutic investigation 1
• Consideration of video capsule endoscopy in certain cases
• High risk of rebleeding, massive hemorrhage, and death in patients with upper GI bleeding 1

From the Research

Causes of Upper GI Bleeding

The most common cause of upper GI bleeding is:

• Peptic ulcer disease, as stated in studies 2, 3, 4, 5

Comparison of Causes

Other options, such as:

• Esophageal varices
• Gastritis
• Mallory-Weiss tear are also causes of upper GI bleeding, but they are not the most common cause, according to the studies 2, 3, 4

Prevalence of Peptic Ulcer Disease

Peptic ulcer disease is a significant cause of morbidity and mortality, with:

• 1% of the population in the US affected by peptic ulcer disease 5
• Approximately 54,000 patients admitted to the hospital annually for bleeding peptic ulcers in the US 5
• 10% of patients presenting with upper abdominal pain in a primary care setting having a peptic ulcer as the cause of their symptoms 5