Upper GI Hemorrhage

Upper GI Hemorrhage – General Information

Upper GI Hemorrhage – Symptoms

The signs and symptoms that are common to the Upper GI Hemorrhage condition can vary from mild to severe, even life-threatening ones. The amount of blood can be small - the health care provider must order some laboratory testing to detect it. This is called a microscopic bleeding and can be observed in the form of iron deficiency anemia. A slow and gradual bleeding may pass unobserved and it may be noticed only when the respective person starts to feel tired and performs anemia testing. Massive bleeding can also appear, consisting in big amounts of pure blood that are passed, and that is why shock and hypovolemia can be developed by any patient if the doctor does not apply the proper treatment at the right moment. In these extreme cases, the patients present an increased risk of death.

The exact percentage of people affected by the medical disorder affecting the digestive tract known as Upper GI Hemorrhage is not known for sure. Other signs and symptoms that could be experienced by some of the patients can include hematochezia, a specific symptom for the upper gastrointestinal bleeding, consisting in significant amounts of blood that the patient is losing, heartburn, hematemesis or melana. If the cause for this medical disorder is the duodenal ulcer, then the patients may experience epigastric pain only after three or four hours after a meal. If the patients suffer from a penetrating ulcer, then this type of pain is more intense and it could radiate to the back area.

Upper GI Hemorrhage – Treatment

The diagnosis for Upper GI Hemorrhage is made only when the patient’s hematemesis test is made. If the patient does not present hematemesis, it is likely to have a gastrointestinal bleeding, especially if he also presents black stool. If the doctor does not find the common signs of this disorder, he can perform a nasogastric aspirate to determine the source of the patient’s bleeding. If the procedure of aspirate proves to be positive, a gastrointestinal bleeding is present, but not all the time. If the aspirate proves to be negative, the diagnosis is not bleeding. But the most effective test that can be made to determine if the patient suffers of Upper GI Hemorrhage is the gastroccult test.

In treating Upper GI Hemorrhage the first treatment option includes aggressive replacement of volume, applying intravenous solutions, and, in rarer cases, blood products. There are cases in which the patient can present esophageal varices, which can progress to coagulopathy, and then the doctor can administrate plasma products. During the treatment, it is very important to monitor the patient’s vital signs. Usually, an endoscopy in the early stages of the condition is recommended, as a diagnosing and therapeutic measure. The treatment depends on the lesions that the patient presents, which can include injection of adrenaline or other sclerotherapy, electrocautery, endoscopic clipping and banding of varices. The risk in suffering from Upper GI Hemorrhage is to develop other more severe complications such as active bleeding, oozing, visible vessels and red spots.

There are cases in which the patient can present blood clots, and the first option is to remove the clots to determine the disease’s pathology and also to determine the risk of causing another bleeding. There are certain medicines that can be used to treat this kind of condition and can include proton pump inhibitors (PPIs), which act by reducing the patient’s gastric acid production and accelerate the healing of certain gastric, duodenal and esophageal sources of bleeding. These kinds of medicines can be given orally or intravenously as an infusion; Octreotide, which is considered a somatostatin analogue acts by shunting the blood away from the splanchnic circulation (the medicine has also proved to be a very useful adjunct in treating both variceal and non-variceal Upper GI Hemorrhage); Terlipressin, which is a somatostatin analog most commonly used in Europe for variceal type of the disease; antibiotics are usually prescribed in treating the disease when it is associated with portal hypertension. There are cases in which the patient can present refractory bleeding and the first treatment option in these cases is to perform certain procedures such as esophagogastroduodenoscopy, balloon tamponade, and angiography to identify and possibly occlude the feeder vessel, or to take certain medicines, such as anti-fibrinolytics, such as tranexamic acid and recombinant Factor VII. There are cases in which surgery may be performed to remove the area of bleeding. This is a disease that requires careful guidance from the doctors.