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. Peptic ulcers are significantly more common than esophageal varices (which are associated with portal hypertension, typically from liver disease), gastritis (inflammation of the stomach lining), or Mallory-Weiss tears (mucosal lacerations at the gastroesophageal junction often caused by forceful vomiting) 1. The bleeding from peptic ulcers can range from slow, chronic blood loss causing anemia to acute, massive hemorrhage requiring emergency intervention. Common risk factors for peptic ulcer disease include H. pylori infection, NSAID use, smoking, alcohol consumption, and stress. Management typically involves acid suppression with proton pump inhibitors, treating any underlying H. pylori infection, and addressing modifiable risk factors.
Some key points to consider in the management of upper GI bleeding include:
- The incidence of nonvariceal UGIB is almost 5 times higher than that of variceal UGIB 1
- Peptic ulcer disease caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drug use is the most common cause of non-variceal UGIB 1
- Esophagogastroduodenoscopy is the usual first-line diagnostic and therapeutic investigation for upper GI bleeding 1
- Video capsule endoscopy is also sometimes used, especially if the bleeding site is suspected to be below the ligament of Treitz 1
Overall, peptic ulcer disease is a significant cause of morbidity and mortality, and prompt recognition and treatment are essential to improve outcomes. The most recent and highest quality study supports the notion that peptic ulcer disease is the most common cause of upper GI bleeding 1.
From the Research
Causes of Upper GI Bleeding
The most common cause of upper GI bleeding is:
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, 5, 6
Key Findings
The studies consistently show that peptic ulcer disease is the leading cause of upper GI bleeding, with other causes being less common. For example, study 2 states that peptic ulcer disease is the most common cause of upper GI bleeding, which is largely due to the intake of NSAIDs and Helicobacter pylori infection. Similarly, study 5 mentions that the most frequent cause of upper GI bleeding is peptic ulcer disease.