Summary about Disease
Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to bleeding in the upper digestive tract (esophagus, stomach, and duodenum) that is not caused by varices (enlarged veins, usually in the esophagus). It is a common medical emergency that can range from mild to life-threatening. The source of bleeding can be diverse, including ulcers, erosions, Mallory-Weiss tears, and tumors. Prompt diagnosis and treatment are crucial to stop the bleeding and prevent complications.
Symptoms
Symptoms of NVUGIB can vary depending on the severity and location of the bleeding. Common symptoms include:
Hematemesis: Vomiting blood (can be bright red or "coffee grounds" in appearance).
Melena: Black, tarry stools.
Hematochezia: Bright red blood in stools (more common with lower GI bleeds, but can occur with brisk upper GI bleeds).
Weakness and Fatigue: Due to blood loss.
Dizziness or Lightheadedness: Especially when standing.
Shortness of Breath: Due to anemia.
Abdominal Pain: May be present, depending on the underlying cause.
Paleness: Due to anemia.
Rapid Heart Rate: The body's response to decreased blood volume.
Loss of consciousness rare symptom in severe bleeding.
Causes
The most common causes of NVUGIB include:
Peptic Ulcers: Sores in the lining of the stomach or duodenum (often caused by Helicobacter pylori infection or NSAID use).
Erosions: Inflammation or injury to the lining of the stomach (erosive gastritis) or esophagus (erosive esophagitis).
Mallory-Weiss Tear: A tear in the lining of the esophagus, often caused by forceful vomiting or retching.
Esophagitis: Inflammation of the esophagus.
Gastritis: Inflammation of the stomach lining.
Duodenitis: Inflammation of the duodenal lining.
Tumors: Cancerous or non-cancerous growths in the esophagus, stomach, or duodenum.
Angiodysplasia: Abnormal blood vessels in the digestive tract.
Dieulafoy's Lesion: An abnormally large artery in the stomach wall that can erode and bleed.
Medicine Used
Medications used to treat NVUGIB depend on the cause and severity of the bleeding. Common medications include:
Proton Pump Inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, pantoprazole, esomeprazole). These are mainstay of treatment.
H2 Receptor Antagonists: Also reduce stomach acid production (e.g., ranitidine, famotidine) though they are less potent than PPIs.
Antibiotics: If Helicobacter pylori infection is present. Common regimens include triple or quadruple therapy (e.g., amoxicillin, clarithromycin, metronidazole, bismuth).
Vasoconstrictors: Reduce blood flow to the digestive tract (e.g., octreotide, somatostatin).
Prokinetics: Promote gastric emptying (e.g., metoclopramide, erythromycin). Useful in clearing the stomach before endoscopy.
Blood Transfusions: To replace lost blood.
Iron Supplements: To treat iron deficiency anemia after the bleeding has stopped.
Is Communicable
NVUGIB itself is not communicable. However, if the bleeding is caused by a *Helicobacter pylori* infection, *H. pylori* can be transmitted from person to person (usually through oral-oral or fecal-oral routes).
Precautions
Precautions to prevent NVUGIB or reduce the risk of recurrence:
Avoid NSAIDs: If possible, or use them with caution and under medical supervision. Take with food or with a PPI.
Limit Alcohol Consumption: Alcohol can irritate the lining of the stomach and esophagus.
Quit Smoking: Smoking increases the risk of ulcers and other GI problems.
Treat H. pylori Infection: If present, follow the prescribed antibiotic regimen.
Manage Stress: Stress can worsen GI symptoms.
Avoid Trigger Foods: Some foods can trigger heartburn or indigestion, which may exacerbate GI problems.
Discuss Medications with Your Doctor: Some medications can increase the risk of GI bleeding.
Adhere to Prescribed Medications: If you have a history of ulcers or other GI problems, take your medications as prescribed.
How long does an outbreak last?
The duration of an NVUGIB episode varies greatly. The bleeding episode itself can last from a few hours to several days, depending on the cause and severity. The underlying condition causing the bleeding (e.g., ulcer, esophagitis) may require weeks or months of treatment to heal completely.
How is it diagnosed?
Diagnosis of NVUGIB typically involves:
Medical History and Physical Exam: To assess symptoms and risk factors.
Blood Tests: To check hemoglobin levels, blood type, and kidney function.
Endoscopy (EGD): A procedure in which a thin, flexible tube with a camera is inserted into the esophagus, stomach, and duodenum to visualize the lining and identify the source of bleeding. Biopsies can be taken during endoscopy.
Stool Tests: To check for blood in the stool (fecal occult blood test).
H. pylori Testing: If suspected, tests include breath test, stool antigen test, or biopsy during endoscopy.
Angiography: (rarely) if endoscopy fails to identify source of bleeding, this procedure uses X-rays and contrast dye to visualize blood vessels.
Timeline of Symptoms
The timeline of symptoms can vary, but a typical scenario might involve:
Initial Stage: Mild symptoms such as heartburn, indigestion, or mild abdominal pain may be present for days or weeks before the acute bleeding episode.
Acute Bleeding: Sudden onset of hematemesis and/or melena. Weakness, dizziness, and other symptoms of blood loss develop as the bleeding progresses.
Post-Bleeding: After the bleeding is controlled, symptoms of anemia (fatigue, weakness, shortness of breath) may persist for several weeks or months until iron stores are replenished.
Important Considerations
NVUGIB is a medical emergency. Seek immediate medical attention if you experience symptoms of upper GI bleeding.
Early diagnosis and treatment are crucial to prevent complications.
Patients with a history of NVUGIB should be closely monitored and managed to prevent recurrence.
Long-term management may involve lifestyle modifications, medications, and regular endoscopic surveillance.
The cause of the bleeding must be identified and treated to prevent further episodes.
Older adults and those with other medical conditions are at higher risk of complications from NVUGIB.