Upper Gastrointestinal Bleeding
Management of Hemorrhage From the Esophagus, Stomach, and Duodenum
Upper GI bleeding requires several steps for management.
Gastrointestinal bleeding is a diagnosis commonly managed by gastroenterologists. Given the length of the digestive tract, there are many causes for GI bleeding. It can be divided into upper GI bleeding and lower GI bleeding, the former of which will be discussed here.
Causes
Upper GI bleeding originates in the GI tract from the mouth to the ligament of Treitz where the duodenum, the first part of the small intestine, ends. Bleeding from the esophagus may occur from esophageal varices, dilation of the veins in the esophagus. This can occur with liver cirrhosis, because blood from the GI tract to the liver backs up when it has difficulty getting through the liver. For the stomach and duodenum, bleeding in these areas can often occur from tumors and ulcers, the latter of which can be due to certain medications (e.g., nonsteroidal anti-inflammatory drugs) or the bacterium Helicobacter pylori. These causes do not comprise a complete list but do represent common causes.
Symptoms and Signs
One of the symptoms of upper GI bleeding is vomiting of blood (hematemesis). If the blood travels through the GI tract, the stool may appear tarry and black (melena) because of digested blood, though the stool can still be stained with red blood (hematochezia). Otherwise, bleeding over time results in anemia, characterized by lower than normal blood hemoglobin and hematocrit with symptoms like weakness, fatigue, and fainting.
Evaluation and Treatment
The most important step to evaluate upper GI bleeding is upper endoscopy. During this procedure, performed by a gastroenterologist, a tube with a camera (endoscope) is passed into the mouth and down the esophagus. The gastroenterologist can proceed to the stomach and duodenum and localize the source of the bleeding, if possible. Any active bleeding can be stopped at the site or sites of origin using mechanical methods (e.g., banding for esophageal varices), thermal methods, or chemical methods (e.g., vasopressin). The necessary tools, including biopsy instruments if necessary to take tissue samples, are brought to the site through the tube portion of the endoscope.
The remainder of treatment addresses the underlying causes of the bleeding. For example, upper GI bleeding due to a large stomach tumor requires surgery, and for patients with stomach and duodenal ulcers, medications like proton-pump inhibitors to halt acid production can slow progression of the ulcer.
Lower GI Bleeding
For information on the causes, symptoms, signs, evaluation, and treatment of lower GI bleeding, click here.
