Upper gastrointestinal bleeding

An upper gastrointestinal hemorrhage (UGH) is considered when there is bleeding spilled into the lumen of the digestive tract whose origin is located above the angle of Treitz, that is, in the esophagus, stomach or duodenum.

Its severity is highly variable, and ranges from small digestive bleeds without general repercussion and massive bleeds that compromise the life of the individual.

Causes of upper gastrointestinal bleeding

The causes of upper gastrointestinal bleeding are multiple, because any injury located in the digestive tract can bleed at a certain time.

We will distinguish the following pathologies according to their location:

Esophagus

• Esophagitis: There are multiple causes that can cause inflammation of the esophagus, but the most common is gastroesophageal reflux disease.
• Esophageal varices: these are dilations of the esophageal vessels secondary to chronic liver disease in most cases. They usually lead to massive bleeding.
•  Esophageal cancer
•  Mallory-Weiss syndrome: it is a lesion of the mucosa of the esophagus secondary to repeated vomiting.
•  Esophageal vascular malformations

Stomach

• Gastric ulcer
• Gastritis: it can be related to the acute or chronic consumption of alcohol, or the use of anti-inflammatories.
• Gastric cancer

Duodenum

• Duodenal ulcer: it is the most common cause of upper gastrointestinal bleeding.

The initial mechanisms by which gastrointestinal bleeding occurs will depend on the responsible cause.

Once the bleeding has started, it can continue for more or less time, give or not spontaneously and be more or less heavy, thus determining the severity of the condition.

In patients with liver cirrhosis , upper gastrointestinal bleeding is a serious complication that can also lead to the development of hepatic encephalopathy .

Symptoms of upper gastrointestinal bleeding

The symptoms of upper gastrointestinal bleeding are conditioned by multiple factors, including the amount of bleeding:

1. If the bleeding is very important and acute, it will lead to a picture of rapid onset, with weakness, dizziness or syncope, paleness and profuse sweating, and may even compromise the life of the patient.
2. In mild, acute or chronic bleeding, the clinic will be much more larval. Thus, chronic bleeding can be asymptomatic for a more or less long time and eventually lead to symptoms derived from the anemia produced.

Apart from these symptoms, upper gastrointestinal bleeding will manifest itself, in the vast majority of cases, through two cardinal signs:

• hematemesis, or vomiting of blood that varies depending on the characteristics of the bleeding:
  – Recent or active: the emitted blood will be bright red
  – Old: it will have a brownish color (vomiting “in coffee grounds”), due to prolonged contact with hydrochloric acid in the stomach.
• melenas, a term referring to the appearance of black, sticky and smelly stools. They are due to the color that the stool acquires when stained by blood. The appearance of manes will always indicate the existence of upper digestive bleeding, although it should be borne in mind that there are certain drugs that can stain the stool black, including iron.

All these symptoms are secondary to the loss of blood, but, in addition, other derivatives of the underlying pathology responsible for the bleeding will appear, if there is an ulcer, for example, the patient may have abdominal pain “in the pit of the stomach”, heartburn or heavy digestions (dyspepsia).

How is it diagnosed?

The clinic, in general, is the one that will give us the diagnosis of upper gastrointestinal bleeding, when we objectify the bleeding.

However, on many occasions, this does not happen and, then, it will be necessary to perform some tests to help us diagnose. We could perform:

• a gastric lavage, in which we will see red blood or “in coffee grounds”, depending on the characteristics of the bleeding.
• we will also have to perform a blood test in order to determine the impact that bleeding has had on the body. In cases of very acute bleeding, we can obtain a normal analysis at the beginning, but, with the passing of the hours, a more or less severe anemia will end up being evidenced. Therefore, it is always necessary to reserve blood, since, perhaps later, we must perform a transfusion.

Treatment of upper gastrointestinal bleeding

Treatment of bleeding as such is hospitable.

It includes the support measures that the patient’s situation requires (intravenous replacement of blood volume, admission or not to the ICU, etc.) and the performance of digestive endoscopy, since it allows stopping bleeding in the vast majority of occasions through of the local injection of certain chemical substances. If the bleeding cannot be stopped in this way, surgical treatment will be necessary.

Treatment of the causes of bleeding will be specific to each one of them.

In the peptic, gastric or duodenal ulcer, treatment with drugs that protect the digestive mucosa from the action of the hydrochloric acid of the stomach, and decrease its secretion (omeprazole, pantoprazole, ranitidine) will be necessary.

How can I avoid it?

There are certain substances that can promote the appearance of an ulcer or gastritis that can, in turn, lead to upper gastrointestinal bleeding. Among them, alcohol in excess and prolonged use of anti-inflammatory drugs stand out.

Therefore, it is very important that you do not take any drug that your doctor has not previously prescribed.

He will be the one to tell you which drug is the most suitable for you and will decide if the administration of stomach protective drugs is necessary to prevent you from having an episode of digestive bleeding.

If you suffer from a chronic disease that can lead to upper gastrointestinal bleeding, you must strictly follow your doctor’s instructions and follow the established treatment to avoid the appearance of complications.

In all cases you should refrain from drinking alcohol and smoking.

Whenever you have hematemesis or melena, you should go to a hospital emergency so that your condition can be assessed and the necessary diagnostic and therapeutic measures are put in place.

Also, you should see your doctor whenever you have symptoms such as heartburn, heartburn, etc. or persistent abdominal pain.