Assessment of upper gastrointestinal bleeding

Patients with UGIB can typically be separated into two groups: those with variceal lesions (either oesophageal or gastric) and those with non-variceal lesions (most commonly peptic ulcers).[Figure caption and citation for the preceding image starts]: Moderate to severe oesophagitis with multiple linear, clean-based oesophageal ulcersFrom the collection of Douglas G. Adler, MD [Citation ends].[Figure caption and citation for the preceding image starts]: Large gastric ulcer along the lesser curvature with a visible vessel in the ulcer bed (arrow)From the collection of Douglas G. Adler, MD [Citation ends].[Figure caption and citation for the preceding image starts]: Large gastric ulcer with large, protuberant visible vesselFrom the collection of Douglas G. Adler, MD [Citation ends].[Figure caption and citation for the preceding image starts]: Grade II oesophageal varices in a patient with portal hypertensionFrom the collection of Douglas G. Adler, MD [Citation ends].​​[Figure caption and citation for the preceding image starts]: Ulcer in the mid-oesophagus with a visible vesselFrom the collection of Douglas G. Adler, MD [Citation ends].

The most frequently encountered aetiologies of UGIB are:[6]Siau K, Chapman W, Sharma N, et al. Management of acute upper gastrointestinal bleeding: an update for the general physician. J R Coll Physicians Edinb. 2017 Sep;47(3):218-30. http://www.rcpe.ac.uk/sites/default/files/jrcpe_47_3_bhala.pdf http://www.ncbi.nlm.nih.gov/pubmed/29465096?tool=bestpractice.com [7]Hearnshaw SA, Logan RF, Lowe D, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011 Oct;60(10):1327-35. http://www.ncbi.nlm.nih.gov/pubmed/21490373?tool=bestpractice.com ​​

• Peptic ulcer disease (26% to 36%)

• Gastritis/erosions (16% to 22%)

• Oesophagitis (17% to 24%)

• No cause found (12% to 17%)

• Erosive duodenitis (9% to 13%)

• Varices (8% to 11%)

• Portal hypertensive gastropathy (4.0% to 4.5%)

• Mallory-Weiss tears (3.0% to 4.3%)

• Malignancy (3.0% to 3.7%)

• Other: including vascular ectasia and haemobilia (2.6%)

UGIB from malignant lesions is usually low-level and chronic, and only infrequently leads to acute bleeding.

It should be noted that varices should not be eliminated as a consideration in young paediatric patients; portal hypertension can be caused by vascular abnormalities and conditions other than alcoholic cirrhosis.

In most patients, likely causes of the bleeding can be ascertained through a thorough history and physical examination.