Upper gastrointestinal bleeding usually refers to bleeding proximal to the ligament of Treitz.
The demographics of the affected individual will depend on the underlying aetiology, which include:
- peptic ulcer disease (PUD) : most common, accounting for ~50% of cases 3
- Mallory-Weiss tear
- vascular abnormality (vascular ectasia, angiodysplasia, Dieulafoy lesion, vascular malformation).
- aorto-duodenal fistula
Classically presents with haematemesis and/or maelena. May present with haematochezia if severe bleeding. Slow bleeding may cause iron deficiency anaemia.
Upper endoscopy is first line investigation and allows for treatment of the bleeding using a variety of endoscopic techniques.
Angiography and embolisation is used in refractory cases, and is generally preferred over surgery. 85% of upper GI haemorrhage is from the left gastric artery territory. Extra-vascular contrast extravasation indicates the site of active bleeding and may be linear (pseudovein sign) or blotchy. Upper GI embolisation is well tolerated because of the rich collateral blood supply. In a patient with significant bleeding, if no active bleeding site is identified on angiography but there is documented upper GI bleeding on endoscopy or NG aspirates, prophylactic embolisation of the left gastric artery is sometimes performed. If there is a bleeding duodenal ulcer and no active extravasation is documented and patient condition is likely to deteriorate empirical embolisation of gastroduodenal artery territory is recommended to prevent life threatening events.
Nuclear scintigraphy is usually not helpful, as it requires relatively brisk active bleeding to be positive, but is often unable to accurately localise the source, above and beyond 'upper gastrointestinal tract'.
- 1. Kandarpa K & Aruny J, Handbook of Interventional Radiologic Procedures, 3rd edition, Lippincott Williams & Wilkins 2002
- 2. Weissleder R. Primer of diagnostic imaging. Mosby Inc. (2007) ISBN:0323040683. Read it at Google Books - Find it at Amazon
- 3. DiMarino AJ, Benjamin SB. Gastrointestinal Disease, An Endoscopic Approach. Slack Incorporated. (2002) ISBN:1556425112. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Upper GI haemorrhage||✗|
|Upper GI hemorrhage||✗|
|Upper gastrointestinal tract haemorrhage||✗|
|Upper gastrointestinal tract hemorrhage||✗|