bleeding refers to any bleeding that starts in the gastrointestinal
tract, which extends from the mouth to the large bowel. It is a
potentially life-threatening abdominal emergency that remains a common
cause of hospitalization. The incidence of upper gastrointestinal
bleeding (UGIB) is approximately 100 cases per 100,000 population per
The degree of bleeding can range from
nearly undetectable (the amount of blood is so small that it can only
be detected by laboratory testing) to acute, massive, and
life-threatening. Prolonged microscopic bleeding can lead to massive
loss of iron, causing anemia. Acute, massive bleeding can lead to
hypovolemia, shock, and even death.
Bleeding may also come from any site along the gastrointestinal tract, but is often divided into:
- Upper GI bleeding: The upper gastrointestinal (GI) tract is located between the mouth and outflow tract of the stomach.
- Lower GI bleeding: The lower GI tract is located from the outflow
tract of the stomach to the anus (small and large bowel included).
Bleeding from the upper GI tract is
approximately 4 times as common as bleeding from the lower GI tract and
is a major cause of morbidity and mortality. Mortality rates from UGIB
are 6-10% overall1.
Causes of UGIB
commonest cause of upper gastrointestinal bleeding (UGIB) is peptic
ulcers. Severe ulcer bleeding is caused by erosion of the artery by the
ulcer with the severity depending on the size of ulcer and the defect.
Large ulcers in the posterior part of the duodenal cap can erode the
gastroduodenal artery and cause rapid bleeding.
Malory-Weiss tears are caused by
retching usually associated with alcohol abuse and other signs of GI
disease, e.g. peptic ulcer, gastroenteritis or have a cause of vomiting
unrelated to the GI tract. Normally, bleeding stops spontaneously.
Bleeding from upper GI neoplasm is
normally not severe and rarely fatal on its own. Esophageal varices are
relatively uncommon but often cause severe bleeding and are associated
with other features of liver disease, e.g. ascites, jaundice,
splenomegaly and fluid retention.
with upper GI hemorrhage often present with hematemesis (vomiting of
blood), coffee ground vomiting, melena (dark tarry stools), or
hematochezia (blood in the feces) if the hemorrhage is severe.
Patients may also present with
complications of anemia, including chest pain, syncope (loss of
consciousness resulting from insufficient blood flow to the brain),
fatigue and shortness of breath.
Diagnostic tests for UGIB
A range of diagnostic tests are ordered for suspected UGIB cases. The initial investigation for UGIB is:
- Full Blood Count
- Coagulation tests (PT, PTT, INR), platelet count, etc
- Esophagogastroduodenoscopy (EGD)
This will determine extent of blood loss and determine if bleeding
is from the stomach or duodemum. For cases where bleeding is not from
the stomach or duodemum, then tests are needed to determine cause of
- Abdominal x-ray
- Abdominal CT scan
- Capsule endoscopy
- Small bowel enteroscopy
- Abdominal MRI scan
- Bleeding scan (tagged red blood cell scan)
UGIB Treatments in NUH
Upper gastrointestinal bleeding (UGIB) is one of the commonest GI emergencies in NUH, with significant mortality and morbidity.
During a 2-year audit performed in 2002-2003, mortality of patients presenting with symptoms of UGIB was 10%2-6,
which is among the standard from renowned international centres. Our
low rate of mortality is related to a dedicated multidisciplinary team
comprising of doctors from departments of Emergency, General Surgery,
and Gastroenterology, and nurses at operating theatre and Endoscopy
- Fallah MA, Prakash C, Edmundowicz S: Acute gastrointestinal bleeding. Med Clin North Am 2000 Sep; 84(5): 1183-208
- Ong TZ, Yeoh KG, Ho KY. Digestive Disease Week 2004
- Exon SJ, Sydney Chung SC. Endoscopic
therapy for upper gastrointestinal bleeding. Best Pract Res Clin
- Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 2004;59:845-64.
- Yavorski RT, Wong RK, Maydonovitch C,
Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper
gastrointestinal bleeding in military medical facilities. Am J
- Vreeburg EM, Snel P, de Bruijne JW,
Bartelsman JF, Rauws EA, Tytgat GN. Acute upper gastrointestinal
bleeding in the Amsterdam area: incidence, diagnosis, and clinical
outcome. Am J Gastroenterol. 1997 Feb;92(2):236-43.
This material does not cover all information and is not intended as a substitute for professional care. Please consult with your physician on any matters regarding your health.
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