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Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and rarer causes such as gastric cancer. The initial assessment includes measurement of the blood pressure and heart rate , as well as blood tests to determine the hemoglobin .
Gastrointestinal bleeding from the upper tract occurs in 50 to 150 per 100,000 adults per year. [8] It is more common than lower gastrointestinal bleeding which is estimated to occur at the rate of 20 to 30 per 100,000 per year. [2] Risk of bleeding is more common in males and increases with age. [2]
The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood (from bleeding in the mouth, nose, or throat), or certain drugs. [citation needed]
Melena is a form of blood in stool which refers to the dark black, tarry feces that are commonly associated with upper gastrointestinal bleeding. [1] The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intestinal bacteria.
Gastric varices are dilated submucosal veins in the lining of the stomach, which can be a life-threatening cause of bleeding in the upper gastrointestinal tract. They are most commonly found in patients with portal hypertension , or elevated pressure in the portal vein system, which may be a complication of cirrhosis .
Hemosuccus pancreaticus is a rare entity, and estimates of its rate are based on small case series. [1] [2] It is the least frequent cause of upper gastrointestinal bleeding (1/1500) and is most often caused by chronic pancreatitis, pancreatic pseudocysts, or pancreatic tumors. [3]
Forrest's classification is instrumental when stratifying patients with upper gastrointestinal hemorrhage into high and low risk categories for mortality.It is also a significant method of prediction of the risk of rebleeding and very often is used for evaluation of the endoscopic intervention modalities. [3]
There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain (see dyspepsia). [1] Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn. [1] [2] Complications may include stomach bleeding, stomach ulcers, and stomach tumors. [1]