Upper Gastrointestinal Bleeding Incidence and Signs

Acute gastrointestinal bleeding is the most common emergency in gastroenterology. Ninety percent of all acute hemorrhages arise in the upper gastrointestinal tract, approximately 9 % in the colon, and approximately 1 % between the ligament of Treitz and the ileocecal valve (Figs. 4.8, 4.9). The incidence is age-dependent, ranging from approximately 30: 100 000 in young individuals to as much as 400: 100 000 in persons over age 75 according to published reports. The overall mortality rate is approximately 15%; it is markedly lower in young patients, rising to 40% in elderly patients with multiple morbidity.

The most frequent cause is ulcer bleeding associated with the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs). This type of bleeding usually occurs early during NSAID use and may occur even at low doses. The concomitant use of corti-costeroids significantly increases the risk, and concurrent anticoagulant use can increase it dramatically.

The main symptoms of upper gastrointestinal bleeding are he-matemesis, melena, and signs of hemorrhagic shock.

The major problems associated with upper gastrointestinal bleeding are hemorrhagic shock and aspiration pneumonia (bleeding and vomiting). They dictate the priorities that are followed in primary treatment:

1. Hemodynamic stabilization

2. Maintenance of adequate respiration

3. Identifying the source of bleeding and hemostasis

4. Prevention of rebleeding

Table 4.2 Upper gastrointestinal bleeding

Cardinal symptoms and likelihood of massive bleeding

Hematemesis 20%

Melena 5-10%

Hematochezia (red blood in the stool)

General symptoms

► Angina pectoris

► Hemorrhagic shock

25% Varices 15-20%

Esophagitis 5-10% Mallory-Weiss syndrome 5% Rare: neoplasms, hemangiomas

Fig. 4.9 Location and relative frequency of acute upper gastrointestinal bleeding

Fig. 4.8 Relative frequency of acute bleeding at different levels in the gastrointestinal tract

Ulcers 20% Erosions 5-10% Others < 10%

- Varices

- Angiodysplasia

- Osler disease

- Neoplasia

- Uncomplicated Dieulafoy ulcer

- Hemangioma

Fig. 4.9 Location and relative frequency of acute upper gastrointestinal bleeding

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