Upper GI bleed: common causes included peptic ulcer disease, varices and Mallory-Weiss tears.

Clinical bottom line (level 2c)

  1. The commonest causes of upper GI bleeding were peptic ulcer disease, varices and Mallory-Weiss tears.
  2. Around 3% of cases were due to malignancy.
Silverstein et al: Gastrointestinal endoscopy 1981; 27 (2): 73-103
Expires November 2002

The study

Setting: acute hospitals, USA

2225 patients (aged 2 to 89; mean 57, 66% male) referred for evaluation and treatment of upper GI bleeding to 227 physicians
94% underwent endoscopy.

The evidence


differential diagnosis number of patients prevalence
(95% CI)
duodenal ulcer 541 24.31%
(22.53% to 26.10%)
gastric erosions 521 23.42%
(21.65% to 25.18%)
gastric ulcer 474 21.3%
(19.6% to 23%)
varices 229 10.29%
(9.0% to 11.55%)
Mallory-Weiss tear 160 7.2%
(6.1% to 8.26%)
oesophagitis 141 6.3%
(5.32% to 7.35%)
erosive duodenitis 128 5.75%
(4.8% to 6.7%)
neoplasm 64 2.88%
(2.18% to 3.57%)
stomal ulcer 41 1.84%
(1.28% to 2.4%)
oesophageal ulcer 37 1.66%
(1.13% to 2.19%)
Osler-Rendu-Weber telangiectasia 11 0.49%
(0.20% to 0.79%)
other 139 6.25%
(5.24% to 7.25%)

Comments

  1. Advances in pharmacological and endoscopy therapy have improved outcomes for patients, but these gains have been counterbalanced by increased age of patients and the high frequency of NSAID drug use.

Citation

  1. Silverstein FE, Gilbert DA, Tedesco FJ, et al: the National ASGE survey on upper gastrointestinal bleeding. Gastrointestinal endoscopy 1981; 27 (2): 73-103
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Contributor: Chris Ball and Musab Hayatli, November 1999
Reviewer: Horand Meier

Clinical Question.
Patient upper GI bleed
Intervention or Exposure causes
Outcome diagnosis, death, surgery, complications