Upper gastrointestinal bleeding (UGIB) refers to gastrointestinal blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Acute UGIB can manifest in a variety of ways, with or without haemodynamic compromise, including haematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, melaena, and, rarely, haematochezia (bright red blood per rectum). Haematochezia is typically only seen with an extremely brisk UGIB; significant haemodynamic compromise is common in these patients.
Causes are multiple, but in developed countries bleeding is usually secondary to peptic ulcer disease (PUD), erosions, oesophagitis, or varices.
UGIB results in more than 250,000 hospital admissions annually in the US, with a mortality of up to 11%. In the UK, UGIB accounts for 70,000 hospital admissions annually, the majority of these being non-variceal in origin, with a mortality of 10%. Ordinarily, mortality is secondary to hypovolaemic shock. Rapid evaluation, haemodynamic resuscitation, and appropriate pharmacological and endoscopic interventions are the cornerstones of therapy.
- Peptic ulcer disease (PUD)
- Oesophageal varices
- Mallory-Weiss tear
- Boerhaave syndrome (spontaneous oesophageal perforation)
- Gastric varices
- Arteriovenous malformations (AVMs)
- Dieulafoy's lesions
- Upper GI tumours
- Aortoenteric fistulae (AEF)
- Haematological management of major haemorrhage
- Upper gastrointestinal and ulcer bleeding
GORD: questions to ask your doctorMore Patient leaflets
Rockall Score for Upper Gastrointestinal Bleeding
Blatchford Score for Gastrointestinal BleedingMore Calculators
Venepuncture and phlebotomy animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer