Evaluation of upper GI bleed

Last reviewed: March 2019

Last updated: June 2018

Summary

Upper gastrointestinal bleeding (UGIB) refers to GI blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Acute UGIB can manifest in a variety of manners, including hematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, and melena with or without hemodynamic compromise. Hematochezia (bright red blood per rectum) may rarely occur in patients with an extremely brisk UGIB. [1] [2] Causes are multiple, but in westernized countries they are usually secondary to either varices or peptic ulcer disease (PUD).

UGIB results in more than 300,000 hospital admissions annually in the US, with a mortality of 7% to 10%. [3] Ordinarily, mortality is secondary to hypovolemic shock. Rapid evaluation, hemodynamic resuscitation, and appropriate pharmacologic and endoscopic interventions are the cornerstones of therapy.

Differentials

Common

Peptic ulcer disease (PUD)
Esophageal varices
Esophagitis
Mallory-Weiss tear

Full details

Uncommon

Boerhaave syndrome (spontaneous esophageal perforation)
Gastric varices
Arteriovenous malformations (AVMs)
Dieulafoy lesion
Upper GI tumors
Aortoenteric fistulae (AEF)
Coagulopathy

Full details

Contributors

Authors VIEW ALL 

Douglas G. Adler, MD, FACG, AGAF, FASGE

Professor of Medicine

Division of Gastroenterology

Department of Internal Medicine

Huntsman Cancer Institute

University of Utah

Salt Lake City

Disclosures

DGA has consulted for BSC and Merit, who make endoscopic retrograde cholangio-pancreatography (ERCP) products. He is also an author of references cited in this topic.

Acknowledgements

Dr Douglas G. Adler would like to gratefully acknowledge the assistance of Dr Patrick D. Martin. PDM declares that he has no competing interests.

Peer reviewers VIEW ALL 

Ned Snyder, MD, FACP

Professor of Medicine

Chief of Clinical Gastroenterology and Hepatology

University of Texas Medical Branch

Galveston

Disclosures

NS declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

Disclosures

DJH declares that he has no competing interests.

Giuseppe Malizia, MD

Consultant Gastroenterologist

Divisione di Gastroenterologia

Ospedale V. Cervello

Palermo

Italy

Disclosures

GM declares that he has no competing interests.

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Evaluation of upper GI bleed

Summary

Differentials

Common

Uncommon

Contributors

Authors VIEW ALL 

Douglas G. Adler, MD, FACG, AGAF, FASGE

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Ned Snyder, MD, FACP

Disclosures

David J. Hackam, MD, PhD

Disclosures

Giuseppe Malizia, MD

Disclosures

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