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| *[[Peptic ulcer]] | | *[[Peptic ulcer]] |
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| ===Common causes===
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| *Peptic ulcer disease<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>
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| *Esophageal varices<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>
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| *Mallory-Weiss syndrome
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| ===Less common causes=== | | ===Less common causes=== |
| *Neoplasms | | *Neoplasms |
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 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 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
Less common causes
- Neoplasms
- Gastric cancer
- Esophageal tumors
- Esophagitis
- Gastric erosions/gastropathy [1]
- Acute erosive gastritis caused by drugs, radiation, infection, or direct trauma.
- Reactive gastropathy 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.[2][3]
- Dieulafoy lesions
- Dilated aberrant submucosal vessels that erode the overlying epithelium in the absence of an ulcer
- Gastric varices
- Gastric antral vascular ectasia
- Dilated gastric vessels of unknown etiology that cause chronic UGIB and iron-deficiency anemia
Rare causes
- Bleeding from the hepatobiliary tract
- Most commonly secondary to a liver or biliary tract injury, from trauma or following procedures or surgery.
- Diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and treated with arteriography
- Aortoenteric fistulas,
- Most commonly involves the lower duodenum.
- Common causes include aortic aneurysms or prosthetic vascular grafts, syphilis and tuberculosis
- Presents with frank UGIB along with a pulsatile mass and abdominal pain radiating to the back.
- Diagnosed by endoscopy.
- Crohn disease involving the upper gastrointestinal tract
- Metastatic malignancy involving the upper gastrointestinal tract, such as melanoma or renal cell carcinoma
- Hemosuccus pancreaticus
- Pancreatic inflammation or cancer may result in bleeding into the pancreatic duct, which connects to the duodenum
Causes by Organ System
| Cardiovascular
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Cholesterol embolism, mesenteric vascular occlusion, vasculitis
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| Chemical/Poisoning
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Arsenic trioxide, arsenicals, caustic ingestion, ethylene glycol, mercury
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| Dental
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No underlying causes
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| Dermatologic
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Craniomandibular dermatodysostosis, Degos disease, dermatomyositis, hereditary haemorrhagic telangiectasia, Osler-Weber-Rendu syndrome, vasculitis
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| Drug Side Effect
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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
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| Ear Nose Throat
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Hereditary haemorrhagic telangiectasia, Osler-Weber-Rendu syndrome
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| Endocrine
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Carcinoid
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| Environmental
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No underlying causes
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| Gastroenterologic
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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
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| Genetic
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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
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| Hematologic
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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
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| Iatrogenic
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Parenteral nutrition-induced liver disease, post-surgical anastomosis, radiation-induced telangiectasia
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| Infectious Disease
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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
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| Musculoskeletal/Orthopedic
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Craniomandibular dermatodysostosis, Ehlers-Danlos syndrome, pelvic fracture
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| Neurologic
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Degos disease, hereditary haemorrhagic telangiectasia, Labrune syndrome, neurofibromatosis type I, Osler-Weber-Rendu syndrome
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| Nutritional/Metabolic
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Carbamoylphosphate synthetase deficiency, hepatorenal tyrosinemia, milk protein intolerance
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| Obstetric/Gynecologic
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Choriocarcinoma, endometriosis, leiomyoma
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| Oncologic
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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
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| Ophthalmologic
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Coats plus syndrome
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| Overdose/Toxicity
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Drug overdose
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| Psychiatric
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No underlying causes
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| Pulmonary
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No underlying causes
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| Renal/Electrolyte
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Cholesterol embolism, chronic renal failure, craniomandibular dermatodysostosis, Henoch-Schoenlein purpura
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| Rheumatology/Immunology/Allergy
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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
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| Sexual
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No underlying causes
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| Trauma
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Trauma
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| Urologic
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No underlying causes
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| Miscellaneous
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Foreign body, swallowed maternal blood
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Causes in Alphabetical Order
References
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