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What is Upper Gastrointestinal Bleeding?

Upper gastrointestinal bleeding (UGIB) refers to haemorrhage or bleeding that occurs in the upper part of the gastrointestinal tract (the oesophagus, the stomach, or the upper segment of the small intestine) as a result of inflammation or injury. It is basically a symptom of an underlying disease condition and is a medical emergency requiring immediate medical attention as it carries a significant morbidity and mortality rate of 6 to 13 per cent. Upper gastrointestinal bleeding is about four times more common than lower gastrointestinal bleeding (LGIB).

Causes of Upper Gastrointestinal Bleeding

Some causes of upper gastrointestinal bleeding include:

  • Peptic ulcer disease: Open sores develop in the upper part of the small intestine or in the lining of your stomach as a result of a bacterial infection.
  • Mallory-Weiss tears: This is a condition characterised by ruptures in the lining or mucous membranes of your lower oesophagus.
  • Oesophageal varices: A condition characterised by swollen or enlarged veins in the lining of the oesophagus.
  • Oesophagitis: Inflammation of the oesophagus usually occurring as a result of gastroesophageal reflux disease or GORD.
  • Enteritis: Inflammation of the small intestine occurs often as a result of bacterial or viral infection.
  • Gastritis: Inflammation of the stomach lining occurs due to infection, inflammatory bowel disease (IBD), injury, or certain medication use.

Risk Factors for Upper Gastrointestinal Bleeding

Some of the risk factors for developing upper gastrointestinal bleeding may include:

  • Previous abdominal surgery
  • Previous history of UGIB
  • Chronic liver or renal disease
  • Medications such as NSAIDs, SSRIs, and corticosteroids

Signs and Symptoms of Upper Gastrointestinal Bleeding

Signs and symptoms of upper gastrointestinal bleeding can be either overt (obvious) or occult (hidden), and depend upon the rate of the bleed and the location of the bleed, which can be anywhere from the beginning of the GI tract (mouth) to the end (anus).

Signs and symptoms may include:

  • Black or tarry stools
  • Vomiting blood that resembles coffee grounds or is bright red
  • Stomach cramps
  • Weakness
  • Pale skin
  • Feeling dizzy, faint, or tired
  • Shortness of breath

Diagnosis of Upper Gastrointestinal Bleeding

Some of the techniques employed for the diagnosis of upper gastrointestinal bleeding include:

  • A review of your medical history, symptoms, and physical examination
  • A stool sample test to check for the presence of blood in the stools
  • A complete blood count test to check for signs of anaemia
  • An endoscopic examination of the upper GI tract in which an endoscope - a thin tubular instrument with a camera, light, and a magnifying lens attached at the end - is passed through the upper GI tract. The camera displays images of the inside of your GI tract to help visualise the source of the bleeding.
  • A procedure called gastric lavage in which the contents of the stomach are removed to determine the source of the bleed
  • Imaging tests such as barium x-rays and CT scans
  • A tissue biopsy in which a sample of the affected area is removed and sent for laboratory analysis

Treatment of Upper Gastrointestinal Bleeding

Several factors, such as the location and cause of the bleeding, and severity of the condition will determine the method of treatment for an upper gastrointestinal bleed. The treatment also involves identify any underlying condition and treating it appropriately. In general, the treatment options may include:

  • Use of antibiotics to treat any underlying bacterial condition causing the bleeding, or use of proton pump inhibitors to inhibit acid production in the stomach and enable healing of the stomach ulcers
  • Refraining from using certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) that may cause stomach ulcers or bleeding
  • Injecting a drug directly into the location of the bleeding in the upper GI tract
  • Targeted heat treatment through a probe or laser at the bleeding site
  • Use of clips to seal the damaged blood vessel causing the bleeding
  • Surgical intervention as a final option if your physician feels no other treatment methods can stop the bleeding

Prevention of Upper Gastrointestinal Bleeding

Healthy lifestyle habits can help prevent the chances of developing underlying conditions that cause upper GI bleeding. Some preventive measures include:

  • Refraining from spicy or acidic foods
  • Refraining from caffeine
  • Refraining from high-fat foods
  • Stopping or limiting the use of NSAIDs
  • Stopping or limiting the use of alcohol
  • Abstaining from smoking

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