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==Overview==
==Overview==
There are many causes for upper GI hemorrhage. Causes are usually anatomically divided into their location in the upper gastrointestinal tract, which could either be [[esophageal]] (for example [[esophageal varices]]) or [[gastric]] (an example is [[gastric ulcer]]) or [[duodenal]] e.g. [[duodenal ulcer]].  Patients are also usually stratified into having either '''[[esophageal varices|variceal]]''' or '''non-variceal''' sources of upper GI hemorrhage, as the two have different treatment algorithms and prognosis.  Other causes could be from infectious diseases, medication side effects, trauma or malignancy e.t.c.
There are many causes for upper gastrointestinal (GI) hemorrhage. Causes are usually anatomically divided into their location in the upper gastrointestinal tract, which could either be [[esophageal]] (for example [[esophageal varices]]) or [[gastric]] (an example is [[gastric ulcer]]) or [[duodenal]] e.g. [[duodenal ulcer]].  Patients are also usually stratified into having either '''[[esophageal varices|variceal]]''' or '''non-variceal''' sources of upper GI hemorrhage, as the two have different treatment algorithms and prognosis.  Other causes could be from infectious diseases, medication side effects, trauma or malignancy and e.t.c.


==Causes==
==Causes==
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===Common Causes===
===Common Causes===
*[[Duodenal ulcer]]<ref name="pmid28798512">{{cite journal |vauthors=Drini M |title=Peptic ulcer disease and non-steroidal anti-inflammatory drugs |journal=Aust Prescr |volume=40 |issue=3 |pages=91–93 |year=2017 |pmid=28798512 |pmc=5478398 |doi=10.18773/austprescr.2017.037 |url=}}</ref><ref name="pmid14959953">{{cite journal |vauthors=Pilotto A, Franceschi M, Leandro G, Paris F, Niro V, Longo MG, D'Ambrosio LP, Andriulli A, Di Mario F |title=The risk of upper gastrointestinal bleeding in elderly users of aspirin and other non-steroidal anti-inflammatory drugs: the role of gastroprotective drugs |journal=Aging Clin Exp Res |volume=15 |issue=6 |pages=494–9 |year=2003 |pmid=14959953 |doi= |url=}}</ref><ref name="pmid23356751">{{cite journal |vauthors=Hreinsson JP, Kalaitzakis E, Gudmundsson S, Björnsson ES |title=Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting |journal=Scand. J. Gastroenterol. |volume=48 |issue=4 |pages=439–47 |year=2013 |pmid=23356751 |pmc=3613943 |doi=10.3109/00365521.2012.763174 |url=}}</ref>
The most common causes of upper gastrointestinal bleeding include:<ref name="pmid14959953">{{cite journal |vauthors=Pilotto A, Franceschi M, Leandro G, Paris F, Niro V, Longo MG, D'Ambrosio LP, Andriulli A, Di Mario F |title=The risk of upper gastrointestinal bleeding in elderly users of aspirin and other non-steroidal anti-inflammatory drugs: the role of gastroprotective drugs |journal=Aging Clin Exp Res |volume=15 |issue=6 |pages=494–9 |year=2003 |pmid=14959953 |doi= |url=}}</ref><ref name="pmid23356751">{{cite journal |vauthors=Hreinsson JP, Kalaitzakis E, Gudmundsson S, Björnsson ES |title=Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting |journal=Scand. J. Gastroenterol. |volume=48 |issue=4 |pages=439–47 |year=2013 |pmid=23356751 |pmc=3613943 |doi=10.3109/00365521.2012.763174 |url=}}</ref><ref name="pmid28798512">{{cite journal |vauthors=Drini M |title=Peptic ulcer disease and non-steroidal anti-inflammatory drugs |journal=Aust Prescr |volume=40 |issue=3 |pages=91–93 |year=2017 |pmid=28798512 |pmc=5478398 |doi=10.18773/austprescr.2017.037 |url=}}</ref>
*[[Duodenal ulcer]]
*[[Esophagitis]]
*[[Esophagitis]]
*[[Esophageal varices]]
*[[Esophageal varices]]
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===Less common causes===
===Less common causes===
Other less common causes of upper gastrointestinal bleeding include:<ref name="pmid20871188">{{cite journal |vauthors=Kaviani MJ, Pirastehfar M, Azari A, Saberifiroozi M |title=Etiology and outcome of patients with upper gastrointestinal bleeding: a study from South of Iran |journal=Saudi J Gastroenterol |volume=16 |issue=4 |pages=253–9 |year=2010 |pmid=20871188 |pmc=2995092 |doi=10.4103/1319-3767.70608 |url=}}</ref><ref name="pmid4078920">{{cite journal |vauthors=Davidson AT |title=Upper gastrointestinal bleeding: causes and treatment |journal=J Natl Med Assoc |volume=77 |issue=11 |pages=944–5 |year=1985 |pmid=4078920 |pmc=2571206 |doi= |url=}}</ref><ref name="pmid18346679">{{cite journal |vauthors=van Leerdam ME |title=Epidemiology of acute upper gastrointestinal bleeding |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=2 |pages=209–24 |year=2008 |pmid=18346679 |doi=10.1016/j.bpg.2007.10.011 |url=}}</ref>
*[[Neoplasms]]
*[[Neoplasms]]
**[[Gastric cancer]]  
**[[Gastric cancer]]  
**[[Esophageal cancer|Esophageal tumors]]
**[[Esophageal cancer|Esophageal tumors]]
*[[Esophagitis]]  
*[[Esophagitis]]  
*Gastric erosions/gastropathy <ref name="pmid20871188">{{cite journal |vauthors=Kaviani MJ, Pirastehfar M, Azari A, Saberifiroozi M |title=Etiology and outcome of patients with upper gastrointestinal bleeding: a study from South of Iran |journal=Saudi J Gastroenterol |volume=16 |issue=4 |pages=253–9 |year=2010 |pmid=20871188 |pmc=2995092 |doi=10.4103/1319-3767.70608 |url=}}</ref>
*Gastric erosions/gastropathy  
** Acute erosive gastritis caused by [[drugs]], [[radiation]], [[infection]], or direct trauma.
** Acute erosive gastritis caused by [[drugs]], [[radiation]], [[infection]], or direct trauma
** Reactive gastropathy may be due to bile reflux, particularly after partial [[gastrectomy]].
** Reactive gastropathy, which may be due to bile reflux, particularly after partial [[gastrectomy]]
** Portal hypertensive gastropathy, which results in increased friability of gastric mucosa in patients with [[cirrhosis]].<ref name="pmid4078920">{{cite journal |vauthors=Davidson AT |title=Upper gastrointestinal bleeding: causes and treatment |journal=J Natl Med Assoc |volume=77 |issue=11 |pages=944–5 |year=1985 |pmid=4078920 |pmc=2571206 |doi= |url=}}</ref><ref name="pmid18346679">{{cite journal |vauthors=van Leerdam ME |title=Epidemiology of acute upper gastrointestinal bleeding |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=2 |pages=209–24 |year=2008 |pmid=18346679 |doi=10.1016/j.bpg.2007.10.011 |url=}}</ref>
** Portal hypertensive gastropathy, which results in increased friability of gastric mucosa in patients with [[cirrhosis]]
*Dieulafoy lesions
*Dieulafoy lesions
**Dilated aberrant submucosal vessels that erode the overlying epithelium in the absence of an [[ulcer]]
**Dilated aberrant submucosal vessels that erode the overlying epithelium in the absence of an [[ulcer]]
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*Aortoenteric fistulas
*Aortoenteric fistulas
**Most commonly involves the lower [[duodenum]].
**Most commonly involves the lower [[duodenum]].
**Common causes include [[Aortic aneurysm|aortic aneurysms]] or prosthetic [[Grafts|vascular grafts]], [[syphilis]] and [[tuberculosis]].
**Common causes include [[Aortic aneurysm|aortic aneurysms]] or prosthetic [[Grafts|vascular grafts]], [[syphilis]] and [[tuberculosis]]  
*[[Crohn's disease]] involving the [[upper gastrointestinal tract]]
*[[Crohn's disease]] involving the [[upper gastrointestinal tract]]
*[[Malignancy|Metastatic malignancy]] involving the [[Upper gastrointestinal tract|upper gastrointestinal tract,]] such as [[melanoma]] or [[renal cell carcinoma]].
*[[Malignancy|Metastatic malignancy]] involving the [[Upper gastrointestinal tract|upper gastrointestinal tract,]] such as [[melanoma]] or [[renal cell carcinoma]]
*[[Hemosuccus pancreaticus]]
*[[Hemosuccus pancreaticus]]
**Pancreatic inflammation or cancer may result in bleeding into the [[pancreatic duct]], which connects to the [[duodenum]].
**Pancreatic inflammation or cancer may result in bleeding into the [[pancreatic duct]], which connects to the [[duodenum]]
 
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! colspan="2" style="background:#efefef;" |Causes of Acute Upper GI bleeding
|-
|Esophagus
|
* Esophagitis
* Mallory–Weiss tear
* Esophageal varices
* Esophageal ulcers
* Esophageal cancer
|-
|Gastric
|
* Gastric ulcer
* Gastric cancer
* Gastritis
* Gastric varices
* Portal hypertensive gastropathy
* Gastric antral vascular ectasia
* Dielafuoy lesions
|-
|Duodenal
|
* Duodenal ulcer
* Vascular malformations, including aorto-enteric
* Fistulae
 
* Bleeding from the bile duct due to
** Liver biopsy
** Trauma
** Arteriovenous malformations
** Liver tumors
|}


===Causes by Organ System===
===Causes by Organ System===

Latest revision as of 19:12, 27 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

There are many causes for upper gastrointestinal (GI) hemorrhage. Causes are usually anatomically divided into their location in the upper gastrointestinal tract, which could either be esophageal (for example esophageal varices) or gastric (an example is gastric ulcer) or duodenal e.g. duodenal ulcer. Patients are also usually stratified into having either variceal or non-variceal sources of upper GI hemorrhage, as the two have different treatment algorithms and prognosis. Other causes could be from infectious diseases, medication side effects, trauma or malignancy and e.t.c.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

The most common causes of upper gastrointestinal bleeding include:[1][2][3]

Less common causes

Other less common causes of upper gastrointestinal bleeding include:[4][5][6]

Rare causes

Causes of Acute Upper GI bleeding
Esophagus
  • Esophagitis
  • Mallory–Weiss tear
  • Esophageal varices
  • Esophageal ulcers
  • Esophageal cancer
Gastric
  • Gastric ulcer
  • Gastric cancer
  • Gastritis
  • Gastric varices
  • Portal hypertensive gastropathy
  • Gastric antral vascular ectasia
  • Dielafuoy lesions
Duodenal
  • Duodenal ulcer
  • Vascular malformations, including aorto-enteric
  • Fistulae
  • Bleeding from the bile duct due to
    • Liver biopsy
    • Trauma
    • Arteriovenous malformations
    • Liver tumors

Causes by Organ System

Cardiovascular Cholesterol embolism, mesenteric vascular occlusion, vasculitis
Chemical/Poisoning Arsenic trioxide, arsenicals, caustic ingestion, ethylene glycol, mercury
Dental No underlying causes
Dermatologic Craniomandibular dermatodysostosis, Degos disease, dermatomyositis, hereditary haemorrhagic telangiectasia, Osler-Weber-Rendu syndrome, vasculitis
Drug Side Effect Alendronate, alosetron, anticoagulants, aspirin, bevacizumab, clopidogrel, colchicine, dicoumarol, Fluorouracil, indomethacin, iron compounds, melarsoprol, NSAIDS, phenprocoumon, phenylbutazone, polyethylene glycol-electrolyte solution (PEG-ES), potassium chloride, quinidine, tetracycline, warfarin, zinc, ziv-aflibercept
Ear Nose Throat Hereditary haemorrhagic telangiectasia, Osler-Weber-Rendu syndrome
Endocrine Carcinoid
Environmental No underlying causes
Gastroenterologic Alcoholic cirrhosis, alcoholic fatty liver, anal fissure, angiodysplasia, aortoenteric fistula, Banti's syndrome, biliary atresia, bowel ischemia, bowel obstruction, bowel strangulation, Budd-Chiari syndrome, chronic portal vein thrombosis, coats plus syndrome, colitis, colitis cystica profunda, colonic diverticulosis, colonic tubular adenomata, colonic villous adenomata, colonoscopy, colorectal cancer, Crohn's disease, Degos disease, Dieulafoy's ulcer, duodenal polypectomy, duodenal ulcer, duodenal webs, duplication cysts, esophageal cancer, esophageal cyst, esophageal varices, esophagitis, familial adenomatous polyposis, Gardner syndrome, gastric antral vascular ectasia, Gastric cancer, gastric polyps, gastric ulcer, gastric varices, gastric volvulus, gastric webs, gastritis, gastroduodenal ulcers, gastrointestinal duplications, hemobilia, hemorrhoids, hemosuccus pancreaticus, hepatic arterioportal fistula, intussusception, liver cirrhosis, Mallory-Weiss syndrome, Mallory-Weiss tear, Meckel's diverticulum, mesenteric vascular occlusion, Ménétrier's disease, peptic ulcer, Peutz-Jeghers syndrome, pneumatosis cystoides intestinalis, portal hypertension, portal hypertensive gastropathy, proctitis, ruptured esophageal varices, solitary rectal ulcer syndrome, stomach cancer, stress gastritis, stress ulcer, superior mesenteric artery occlusion, ulcerative colitis, watermelon stomach, Zollinger-Ellison syndrome
Genetic Banti's syndrome, carbamoylphosphate synthetase deficiency, coats plus syndrome, Crohn's disease, Ehlers-Danlos syndrome, familial adenomatous polyposis, Gardner syndrome, hepatorenal tyrosinemia, Kasabach-Merritt syndrome, neurofibromatosis type I, Peutz-Jeghers syndrome, pseudoxanthoma elasticum, Wiskott-Aldrich syndrome
Hematologic Blood clotting disorders, carcinoid, coagulopathy, essential thrombocytosis, hemophilia, haemorrhagic disease of the newborn, hemorrhagic thrombocythemia, Henoch-Schoenlein purpura, iron deficiency anemia, Kasabach-Merritt syndrome, systemic mastocytosis, thrombocytopenia, Wiskott-Aldrich syndrome
Iatrogenic Parenteral nutrition-induced liver disease, post-surgical anastomosis, radiation-induced telangiectasia
Infectious Disease Acanthocephaliasis, ancylostoma duodenale, angiostrongyliasis, anthrax, bacillary dysentery, balantidiasis, candida albicans, cytomegalovirus, ebola virus, entamoeba histolytica, giardiasis, helicobacter pylori, herpes simplex virus, Katayama fever , necator americanus (hookworm), parasites, schistosoma mansoni, strongyloidiasis, trichuriasis, typhoid fever, yellow fever
Musculoskeletal/Orthopedic Craniomandibular dermatodysostosis, Ehlers-Danlos syndrome, pelvic fracture
Neurologic Degos disease, hereditary haemorrhagic telangiectasia, Labrune syndrome, neurofibromatosis type I, Osler-Weber-Rendu syndrome
Nutritional/Metabolic Carbamoylphosphate synthetase deficiency, hepatorenal tyrosinemia, milk protein intolerance
Obstetric/Gynecologic Choriocarcinoma, endometriosis, leiomyoma
Oncologic Adenocarcinoma, anal cancer, blue rubber bleb nevus syndrome, carcinoid, cecal carcinoma, choriocarcinoma, colorectal cancer, esophageal cancer, familial adenomatous polyposis, Gardner syndrome, gastric cancer, hemangiomas, kaposi sarcoma, lipoma, lymphoma, malignancy, melanoma, mesenchymal neoplasm, metastatic tumor, Peutz-Jeghers syndrome, small bowel cancer, small bowel lymphoma, small bowel tumors, stomach cancer, systemic mastocytosis, tumors
Ophthalmologic Coats plus syndrome
Overdose/Toxicity Drug overdose
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Cholesterol embolism, chronic renal failure, craniomandibular dermatodysostosis, Henoch-Schoenlein purpura
Rheumatology/Immunology/Allergy Crohn's disease, dermatomyositis, food allergy, food protein-induced enterocolitis syndrome (FPIES), Henoch-Schoenlein purpura, microscopic polyangiitis, polyarteritis nodosa, systemic mastocytosis, vasculitis, Wiskott-Aldrich syndrome
Sexual No underlying causes
Trauma Trauma
Urologic No underlying causes
Miscellaneous Foreign body, swallowed maternal blood

Causes in Alphabetical Order

References

  1. ↑ Pilotto A, Franceschi M, Leandro G, Paris F, Niro V, Longo MG, D'Ambrosio LP, Andriulli A, Di Mario F (2003). "The risk of upper gastrointestinal bleeding in elderly users of aspirin and other non-steroidal anti-inflammatory drugs: the role of gastroprotective drugs". Aging Clin Exp Res. 15 (6): 494–9. PMID 14959953.
  2. ↑ Hreinsson JP, Kalaitzakis E, Gudmundsson S, Björnsson ES (2013). "Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting". Scand. J. Gastroenterol. 48 (4): 439–47. doi:10.3109/00365521.2012.763174. PMC 3613943. PMID 23356751.
  3. ↑ Drini M (2017). "Peptic ulcer disease and non-steroidal anti-inflammatory drugs". Aust Prescr. 40 (3): 91–93. doi:10.18773/austprescr.2017.037. PMC 5478398. PMID 28798512.
  4. ↑ Kaviani MJ, Pirastehfar M, Azari A, Saberifiroozi M (2010). "Etiology and outcome of patients with upper gastrointestinal bleeding: a study from South of Iran". Saudi J Gastroenterol. 16 (4): 253–9. doi:10.4103/1319-3767.70608. PMC 2995092. PMID 20871188.
  5. ↑ Davidson AT (1985). "Upper gastrointestinal bleeding: causes and treatment". J Natl Med Assoc. 77 (11): 944–5. PMC 2571206. PMID 4078920.
  6. ↑ van Leerdam ME (2008). "Epidemiology of acute upper gastrointestinal bleeding". Best Pract Res Clin Gastroenterol. 22 (2): 209–24. doi:10.1016/j.bpg.2007.10.011. PMID 18346679.

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