Upper gastrointestinal hemorrhage is bleeding that occurs at a site proximal to the ligament of Treitz. This life-threatening event is frequently a consequence of peptic ulcer disease although there are other causes as well. The clinical presentation features primarily hematemesis, melena, and epigastric pain.
Upper gastrointestinal hemorrhage (UGIH) describes bleeding arising from a site proximal to the ligament of Treitz  . The leading etiology of UGIH is peptic ulcer disease (PUD), which accounts for 60% of cases and is significantly associated with Helicobacter pylori infection  . Other potential causes are Mallory-Weiss tear, gastritis, duodenitis, arteriovenous malformations, esophageal varices, and malignancy  . Important risk factors are a history of nonsteroidal anti-inflammatory drug (NSAID) use, alcohol abuse, and chronic renal failure . Other risk factors include chronic liver disease, portal hypertension, and use of certain medications.
UGIH is more predominant in men and in advanced ages . Patients typically report signs such as melena, hematochezia, hematemesis, epigastric or generalized abdominal pain, presyncope, and heartburn . In acute hemorrhage, hematemesis and melena are frequent complaints. Other possible manifestations are chest pain, dysphagia, weight loss, jaundice, and syncope  .
UGIH is associated with significant morbidity and mortality. Moreover, the risk of death is correlated with factors such as older age and the presence of comorbidities  . Another complication is rebleeding, which occurs in 15% of patients .
In patients with suspected UGIH, rapid triage will allow the clinician to promptly identify and subsequently resuscitate hemodynamically unstable patients . Furthermore, the clinician should elicit the patient's personal history, the list of medications, and risk factors.
Vital signs are used to assess whether the patient is hemodynamically stable or not. Worrisome signs are tachycardia, hypotension (systolic blood pressure < 90 mm Hg), orthostatic hypotension, and findings indicative of poor perfusion such as cool extremities.
Remarkable abdominal exam findings may contain rebound tenderness, guarding, and evidence of chronic liver disease, while a rectal exam may reveal the presence of blood .
A complete blood count (CBC), which is key to gauge the blood loss, should be obtained every 4 to 6 hours in order to track and follow the trends. Other important tests are incorporated in a complete metabolic panel (CMP), which evaluates renal and liver function, electrolyte levels, and other parameters, while a coagulation profile is obtained to assess possible coagulopathy. Moreover, a type and cross match is required in case a transfusion is warranted .
Stabilized patients will undergo upper endoscopy, which is the recommended initial diagnostic study for UGIH . This procedure also allows for endoscopic treatment as well . There may be a role for the use of capsule endoscopy (CE) to identify patients with low-risk lesions .
Nasogastric lavage is utilized to help confirm bleeding and allows for visualization and characterization of the contents.
To evaluate for pathologies such as cirrhosis, pancreatitis, and other rare causes of UGIH, imaging modalities such as computed tomography (CT) scan and ultrasonography are useful . Additionally, chest radiography is used to exclude aspiration pneumonia, esophageal perforation, and other manifestations.
In patients with a negative endoscopy and those with bleeding that is refractory to endoscopic treatment, angiography with transcatheter arterial embolization (TAE) should be considered .
An electrocardiogram (EKG) is used to rule out acute myocardial infarction, arrhythmias, and other cardiac-related consequences.