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 hemodynamic compromise, including hematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, melena, and, rarely, hematochezia (bright red blood per rectum). Hematochezia is typically only seen with an extremely brisk UGIB; significant hemodynamic compromise is common in these patients.[1] [2]
Causes are multiple, but in developed countries bleeding is usually secondary to peptic ulcer disease (PUD), erosions, esophagitis, or varices.
In one systematic review of patients with gastrointestinal bleeding assessing international data between 1980-2012, incidence rates of UGIB ranged from 15.0 to 172.0 per 100,000 person-years.[3] The systematic review also showed an overall decline in the incidence of UGIB over time. This may partly be due to increases in the outpatient treatment of those deemed to be at low risk (therefore not being included in hospital admission figures); other likely causes include increased use of proton-pump inhibitors and eradication of Helicobacter pylori, decreased use of drugs that increase the risk of bleeding (e.g., selective serotonin reuptake inhibitors, nonsteroidal anti-inflammatory drugs) in at-risk patients, and reduced levels of social deprivation.[3]
UGIB results in more than 250,000 hospital admissions annually in the US, with a mortality of up to 11%.[4] [5] Ordinarily, mortality is secondary to hypovolemic shock. Rapid evaluation, hemodynamic resuscitation, and appropriate pharmacologic and endoscopic interventions are the cornerstones of therapy.
