Does your stomach do what it wants? Beware of upper gastrointestinal bleeding

Author: Li Teng, Suzhou Hospital Affiliated to Anhui Medical University

Reviewer: Cao Jie, Chief Physician, Suzhou Hospital Affiliated to Anhui Medical University, Vice President of Gastroenterology Society of Anhui General Practice Association, Standing Committee Member of Digestive Endoscopy Society of Anhui Medical Association, Standing Committee Member of Digestive Endoscopy Professional Committee of Anhui Anti-Cancer Association

With the improvement of living standards and the quickening pace of life, irregular meals, unhealthy diet and unhealthy lifestyle may all become the triggers of "upper gastrointestinal bleeding", an invisible health killer, which deserves our in-depth understanding and vigilance.

1. What is the definition of upper gastrointestinal bleeding?

Upper gastrointestinal bleeding refers to bleeding caused by lesions above the Treitz ligament (including the esophagus, stomach, duodenum, pancreatic duct, and bile duct). Bleeding caused by lesions in the upper jejunum near the anastomosis after gastrojejunostomy also falls into this category. Clinical manifestations include hematemesis, black stools, and blood in the stool.

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2. What are the causes of upper gastrointestinal bleeding?

1. Peptic ulcer is the most common cause of upper gastrointestinal bleeding.

2. Rupture of esophageal varices is the main clinical manifestation of portal hypertension, which is mainly caused by liver cirrhosis.

3. Common causes of acute erosive hemorrhagic gastritis are stress states (such as severe trauma, surgery, multiple organ failure, etc.), as well as drugs (such as non-steroidal anti-inflammatory drugs), ethanol, physical factors, etc., which cause gastric mucosal erosion and bleeding.

4. Upper gastrointestinal bleeding caused by gastric cancer is a common complication of gastric cancer. It often appears in the early stages and manifests as vomiting blood, black stools, and positive occult blood in stools.

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5. Other causes of gastrointestinal bleeding include: ① esophageal diseases, such as esophageal cardia mucosal laceration, esophageal cancer, esophageal injury, esophagitis, esophageal diverticulitis, aortic aneurysm rupture into the esophagus, etc.; ② gastroduodenal diseases, such as polyps, gastric stromal tumors, portal hypertensive gastropathy, hemangioma, anastomotic ulcer, duodenal diverticulum, etc.

3. What are the clinical symptoms of upper gastrointestinal bleeding?

1. Vomiting blood: When the amount of bleeding is large and the bleeding speed is fast, the vomited blood will be purple or bright red. If the blood is retained in the stomach and comes into contact with gastric acid, it will be converted into acidified iron hemoglobin, making the vomited blood brown or coffee grounds-like.

2. Black stool: When blood stays in the intestine for a long time, the iron in the hemoglobin in the blood combines with the sulfide in the intestine through the action of bacteria to form iron sulfide, which makes the stool black and tarry. Black stool can be caused when the amount of bleeding exceeds 50ml.

3. Anemia: caused by excessive blood loss. Acute massive bleeding can lead to hemorrhagic anemia.

4. Hemorrhagic peripheral circulatory failure: When the amount of bleeding does not exceed 400ml at one time, it generally does not cause systemic symptoms. When the amount of bleeding exceeds 1000ml or 20% of the total body's effective blood volume in a short period of time, it will cause symptoms of peripheral circulatory failure, such as obvious dizziness, pale and cold skin, thirst, decreased blood pressure, decreased urine volume, etc.

5. Fever: Some patients may develop a low fever after massive gastrointestinal bleeding. The body temperature generally does not exceed 38.5°C and returns to normal after 3 to 5 days.

4. How to diagnose upper gastrointestinal bleeding?

Endoscopic examination and endoscopic hemostasis are key examinations to identify the lesions of gastrointestinal bleeding. Emergency gastroscopy should be performed within 24 to 48 hours after bleeding and when vital signs are stable.

5. What are the treatments for upper gastrointestinal bleeding?

Drug treatment includes H2 receptor antagonists, which can reduce the secretion of gastric acid and intestinal glands and promote ulcer healing; proton pump inhibitors can effectively inhibit gastric acid secretion and reduce further erosion of the ulcer surface; somatostatin and its mimetics can reduce the pressure of esophageal and gastric varicose veins and inhibit glucagon secretion. In addition, there are hemostatic drugs such as vitamin K1, sulfonylmethane, norepinephrine, thrombin lyophilized powder, etc. If the amount of bleeding is large, blood transfusion is required in time.

Other treatments include compression hemostasis with a three-lumen two-balloon catheter, sclerotherapy, endoscopic hemostasis (such as thermocoagulation, sclerotherapy, or titanium clip hemostasis), surgery, and interventional therapy (such as mesenteric angiography hemostasis).

6. During upper gastrointestinal bleeding, patients and their families need to pay special attention to the following aspects to ensure safety and promote recovery

1. Diet management: Use soft food or liquid diet. In the early stage, you may need to start with a liquid diet (such as rice soup, juice), eat small meals frequently, and gradually transition to semi-liquid food (such as porridge, soft noodles) and then to soft food (such as cooked vegetables, fish, etc.). Avoid rough, spicy, and fried foods.

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2. Drug treatment: Take medication as prescribed by your doctor, including hemostatics, antacids, antibiotics (if there is a risk of infection), etc. Avoid using nonsteroidal anti-inflammatory drugs that may damage the gastric mucosa.

3. Lifestyle adjustment: quit smoking and drinking, exercise moderately, and control your weight. Depending on your physical condition, moderate physical activity with the doctor's permission can help improve blood circulation and strengthen your physical fitness.

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4. Regular follow-up: Return to the hospital for regular follow-up according to the schedule arranged by the doctor.

5. Psychological support: regulate emotions and get family support. Family understanding and support are very important for the patient's recovery.

6. Prevent rebleeding: Understand and avoid the causes, learn about the disease, understand which factors may cause rebleeding, and try to avoid them.

7. Patients with upper gastrointestinal bleeding have an acute onset and high mortality rate. Shortening the early treatment time is the key to improving the success rate of treatment.

Preventive measures include:

1. Regular diet: Eat three meals at regular times and in regular amounts, avoid overeating, and chew slowly.

2. Regular life and work schedule: Ensure adequate sleep and maintain a regular work and work schedule. Moderate physical exercise, such as walking and jogging, can help strengthen your physique and improve your immunity.

3. Treat the primary disease: For diseases such as peptic ulcer and liver cirrhosis, follow the doctor's advice for the full course of treatment and have regular check-ups.

4. Use medication with caution: Avoid taking medication that may damage the gastric mucosa (such as nonsteroidal anti-inflammatory drugs, hormone drugs, etc.). If you must take medication, use it under the guidance of a doctor and add a gastric mucosal protective agent.

5. Regulate your emotions: Keep a happy mood and avoid excessive tension and stress.

Autumn is the peak season for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding can be effectively reduced through a reasonable diet, a regular lifestyle, active treatment of underlying diseases, rational medication, and emotional regulation. In particular, high-risk groups with a history of ulcer disease, liver cirrhosis, gastric cancer, etc. should be more vigilant and carry out targeted prevention and treatment under the guidance of a doctor. Let us pay attention to our health together and stay away from the threat of upper gastrointestinal bleeding.