How to treat upper gastrointestinal bleeding?

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 15, 2024
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After gastrointestinal bleeding, the patient should be kept in a recumbent position to rest and ensure that the airway is clear to avoid aspiration of blood due to vomiting. Close monitoring of the patient's vital signs, such as heart rate, blood pressure, and breathing, is necessary. It is important to actively replenish blood volume, correct hypovolemic shock, and administer medications for hemostasis. Endoscopic hemostasis with a gastroscope can also be used. If conservative drug treatment is not effective, surgical treatment may be considered. Emergency treatment is essential after gastrointestinal bleeding, as delays can be life-threatening.

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Written by Wang Li Bing
Intensive Care Medicine Department
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The most common cause of upper gastrointestinal bleeding

Upper gastrointestinal (GI) bleeding is very common in clinical settings, and the main causes of upper GI bleeding include the following: First, gastric and duodenal ulcers, esophageal diseases. Second, esophageal and gastric fundal varices rupture caused by portal hypertension. Third, diseases of organs or tissues adjacent to the upper digestive tract, such as biliary bleeding or pancreatic diseases involving the duodenum, such as pancreatic cancer, as well as aortic aneurysms breaking into the esophagus, stomach, or duodenum. Fourth, systemic diseases, such as allergic purpura, hemophilia, etc., can all lead to upper GI bleeding. After such bleeding occurs, it is essential to seek medical attention promptly.

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Written by Wu Hai Wu
Gastroenterology
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The cause of vomiting coffee-colored substances due to upper gastrointestinal bleeding.

Upper gastrointestinal bleeding results in the vomiting of coffee-colored blood because the combination of fresh blood with stomach acid forms a coffee-colored liquid. If the bleeding volume exceeds 200mL in a short period, coffee-colored vomit may occur. It is necessary to seek prompt medical attention at a regular hospital’s gastroenterology or emergency department. Adequate diagnosis with an electronic gastroscopy is essential to identify the source and location of the bleeding, and active endoscopic treatment should be undertaken. Additionally, it is crucial to actively replenish fluids, correct the loss of body water, and restore blood volume. Treatment should also include the use of proton pump inhibitors and gastric mucosal protectants.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Is upper gastrointestinal bleeding dangerous?

Upper gastrointestinal bleeding is life-threatening if the amount and speed of bleeding are substantial. Therefore, proactive and effective measures should be taken to rescue the patient. Generally, after anti-shock treatment and rapid blood volume replenishment, the patient's life can be saved. The main clinical treatment measures include the following: First, keep the patient in a recumbent position at rest, ensure that the airway is clear, and prevent blood aspiration due to vomiting. Second, during the bleeding period, it is necessary to enforce fasting, closely monitor the patient's vital signs, such as heartbeat, breathing, blood pressure, consciousness, etc. Third, after hospitalization, it is crucial to actively replenish blood volume, such as transfusing compatible red blood cells, plasma, cryoprecipitate, etc., for fluid expansion. Drugs like proton pump inhibitors and octreotide can be used for hemostasis. If conditions permit, a gastroscopy can be performed to stop the bleeding, and surgical treatment may be considered if necessary.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Upper digestive tract bleeding vomit color

The color of vomit in upper gastrointestinal bleeding primarily relates to the amount of bleeding and the speed of bleeding. If the patient has minor bleeding, the gastric acid may process it, resulting in the vomiting of a coffee-ground-like substance, indicating a smaller amount of bleeding. If the patient has substantial bleeding at a rapid pace, surpassing the gastric acid processing, fresh blood may often be vomited, indicating significant bleeding and a poor prognosis. After upper gastrointestinal bleeding occurs, it is crucial to seek medical attention immediately. In clinical settings, patients are usually given proton pump inhibitors and somatostatin analog drugs to stop the bleeding, and it is vital to promptly conduct a thorough gastroscopy to ascertain the causes of gastrointestinal bleeding and so forth.

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Written by Jiang Guo Ming
Gastroenterology
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Upper gastrointestinal bleeding causes

The most common cause of upper gastrointestinal bleeding is likely peptic ulcers, such as stomach ulcers, duodenal bulb ulcers, and compound ulcers. Other conditions, such as acute gastric mucosal lesions caused by medication, can also lead to gastrointestinal bleeding. Gastrointestinal tumors, such as esophageal cancer, stomach cancer, and duodenal cancer, can also invade blood vessels and cause upper gastrointestinal bleeding. Vascular diseases, such as varicose veins of the esophagus and stomach base caused by liver cirrhosis, can rupture and lead to upper gastrointestinal bleeding. Massive bleeding can also occur due to the rupture of the gastric artery. Other conditions, like systemic diseases and blood disorders, can lead to thrombocytopenia or coagulation dysfunction, which can also result in upper gastrointestinal bleeding.