Digestive Hemorrhage High: Symptoms, Diagnosis, Causes, Treatment and Risk Factors

It is characterized as a potentially fatal emergency and requires immediate hospitalization. It is defined as a loss of serious blood with various causes.

In the case of   upper gastrointestinal bleeding, it is derived from a source proximal to the ligament of Treitz.

Signs and symptoms

High Digestive Hemorrhage presents the following symptoms:

  • Epigastric pain.
  • Acidity.
  • Diffuse abdominal pain.
  • Dysphagia .
  • Jaundice .
  • Weightloss.
  • Decompensation of the body.
  • Nervous sweating
  • General discomfort.

Causes

Peptic ulcer disease remains the most common cause of High Digestive Hemorrhage.

In a review of the literature involving more than 10,000 patients with High Digestive Hemorrhage, peptic ulcer was responsible for 27-40% of all bleeding episodes.

Peptic ulcer is strongly associated with Helicobacter pylori infection.

The organism causes the alteration of the mucosal barrier and has a direct inflammatory effect on the gastric and duodenal mucosa, reducing the defenses of the mucosa and increasing the diffusion of acid after loosening the narrow cell junctions.

Duodenal ulcers are more common than gastric ulcers, but the incidence of bleeding is identical for both.

In most cases, bleeding is caused by erosion of an artery at the base of the ulcer. In approximately 80% of patients, bleeding from a peptic ulcer stops spontaneously.

A minority of patients experience recurrent bleeding after endoscopic treatment, and these cases are usually associated with risk factors for rebleeding.

These factors include age over 60 years, the presence of shock on admission, coagulopathy, active pulsatile bleeding and the presence of cardiovascular disease.

Other causes of High Digestive Hemorrhage:

Other important causes of High Digestive Hemorrhage are tears of the esophageal mucosa, erosive esophagitis, erosive gastritis, Dieulafoy’s lesion,  ulcerated gastric leiomyoma and gastric cancer.

Patients with chronic liver disease and hypertension have an increased risk of bleeding or ulcerative hemorrhage.

The rare causes of upper gastrointestinal bleeding include gastric antral vascular ectasia, aortoenteric fistula, Osler-Weber-Rendu syndrome, and angiectasia.

Diagnosis

To determine if the affected person suffers from a High Digestive Hemorrhage, the attending physician must perform the following studies:

  • Complete blood count with differential.
  • Basic metabolic profile, blood urea nitrogen and coagulation profile.
  • Level of hemoglobin.
  • Level Gastrin .
  • Calcium level
  • Endoscopy.
  • Nasogastric washing.
  • Chest x-ray.
  • Angiography (if the bleeding persists and the endoscopy does not identify a bleeding site).

Treatment

The treating physician must identify the causes of the bleeding to determine the treatment, for this, the first thing to do is the following:

  • Replace each milliliter of blood loss with 3 ml of crystalloid fluid.
  • In patients with serious medical conditions that coexist, a catheter should be placed in the pulmonary artery to control the hemodynamic cardiac output.
  • Placement of the Foley catheter for continuous assessment of urinary output as a guide for renal perfusion.
  • Endoscopic haemostatic therapy for bleeding ulcers and varicose veins.
  • Surgical repair of the perforated viscus .
  • For patients with high-risk peptic ulcer, high doses of intravenous proton pump inhibitors.

The indications for surgery in patients with Upper Digestive Hemorrhage should have a perforation, obstruction, malignancy or also:

  • Severe and life-threatening hemorrhage that does not respond to resuscitation efforts.
  • Failure of medical therapy and endoscopic haemostasis with persistent recurrent bleeding.
  • Prolonged bleeding, with loss of 50% or more of the blood volume.
  • A second hospitalization for hemorrhage due to peptic ulcer.

Risk factor’s

The incidence of Upper Digestive Hemorrhage is approximately 100 cases per 100,000 inhabitants per year.

Bleeding from the upper gastrointestinal tract is approximately 4 times more common than bleeding from the lower gastrointestinal tract and is an important cause of morbidity and mortality.

The mortality rates of High Digestive Hemorrhage are 6-10% in general.

In patients with High Digestive Hemorrhage, it has been observed in 50.9% of patients, with similar occurrences in men (48.7%) and women (55.4%).

Rebleeding or continuous bleeding is associated with increased mortality, therefore, it is imperative to differentiate the patient with a low probability of rebleeding or a high probability of rebleeding.