Gut Instincts: A Clinician's Handbook of Digestive and Liver Diseases

Eric Esrailian, MD, MPH

Chapter 9: Nonvariceal Upper Gastrointestinal Bleeding (continued)

Kevin A. Ghassemi, MD; Dennis M. Jensen, MD

Upper gastrointestinal (UGI) bleeding occurs proximal to the ligament of Treitz. It presents usually as either hematemesis (vomiting of blood or coffee ground-like material) or melena (black, tarry stool). In about 15% to 20% of severe cases, it can manifest as hematochezia (red blood or clots per rectum). The most common cause of UGI bleeding is from an ulcer (40% of cases). Other causes of UGI bleeding are esophageal or gastric varices (16%), esophagitis (13%), UGI tumor (7%), vascular ectasia (6%), Mallory-Weiss tear (4%), Dieulafoy’s lesions and watermelon stomach (2% each). This…