GI Bleeding

Upper gastrointestinal (GI) bleeding refers to bleeding that occurs in the upper part of the digestive system, typically from the esophagus, stomach, or duodenum. It can manifest as hematemesis (vomiting blood), melena (black, tarry stools), or less commonly, hematochezia (passage of red blood through the rectum). Upper GI endoscopy plays a pivotal role in diagnosing and managing upper GI bleeding.

Symptoms

• Hematemesis: Vomiting bright red blood or coffee-ground-like material.
• Melena: Black, tarry stools with a distinct foul smell, indicating digested blood.
• Fatigue and Weakness: Due to significant blood loss and anemia.
• Pallor and Dizziness: Signs of hypovolemia and anemia.
• Abdominal Pain: Suggestive of ulcers or other underlying causes.

Causes

• Peptic Ulcer Disease (PUD): The leading cause, often related to H. pylori infection or NSAID use.
• Esophageal Varices: Dilated veins in the esophagus, commonly seen in liver cirrhosis, which can rupture and bleed.
• Gastritis: Inflammation of the stomach lining, often caused by alcohol, stress, or medications.
• Mallory-Weiss Tear: Tears in the mucosa at the gastroesophageal junction caused by severe vomiting or retching.
• Gastrointestinal Malignancies: Cancers of the stomach or esophagus.
• Arteriovenous Malformations (AVMs): Abnormal blood vessel formations in the GI tract.

Diagnosis and Role of Upper GI Endoscopy

Upper GI endoscopy (esophagogastroduodenoscopy) is the gold standard for evaluating upper GI bleeding. It involves inserting a flexible tube with a camera through the mouth to visualize the esophagus, stomach, and duodenum. This procedure helps identify the bleeding source, assess its severity, and often provides therapeutic interventions.

Treatment

• Initial Stabilization: Includes IV fluids, blood transfusion, and correction of coagulopathy.
• Pharmacological Management: Proton pump inhibitors (PPIs) to reduce gastric acid and somatostatin analogs for variceal bleeding.
• Endoscopic Interventions: Techniques such as clipping, band ligation, sclerotherapy, or thermal coagulation to stop bleeding.
• Surgical or Radiological Interventions: For refractory cases, surgery or angiographic embolization may be required.