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. 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 1. According to the most recent evidence, peptic ulcer disease caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drug use is the leading cause of non-variceal upper GI bleeding 1. The other causes of nonvariceal upper GI bleeding, such as Mallory-Weiss tears, esophagitis, pancreatitis, trauma, iatrogenic, or neoplastic, are less common.

Some key points to consider:

• Peptic ulcer disease is a significant cause of morbidity and mortality, with a high risk of rebleeding, massive hemorrhage, and death 1.
• The initial management of nonvariceal upper GI bleeding focuses on resuscitation, maintenance of hemodynamic stability, and triage (in-patient versus intensive care unit care) 1.
• Esophagogastroduodenoscopy is the usual first-line diagnostic and therapeutic investigation for upper GI bleeding, as recommended by the American College of Gastroenterology practice guidelines and an American Gastroenterological Association expert statement 1.
• The high prevalence of peptic ulcer disease as a bleeding source relates to the widespread use of NSAIDs and the presence of H. pylori infection in many populations, both of which are major risk factors for ulcer formation and subsequent bleeding 1.

Overall, peptic ulcer disease is the most common cause of upper GI bleeding, and its management should prioritize resuscitation, hemodynamic stability, and prompt diagnostic evaluation with esophagogastroduodenoscopy.

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