What is Non-Variceal Upper Gastrointestinal Bleeding?

Introduction:

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a condition in which the digestive tract has major symptoms, such as bleeding in the gastrointestinal (GI) tract. The digestive tract comprises the esophagus, stomach, small intestine, duodenum, large intestine, or colon, rectum, and anus. Any of these organs may experience GI bleeding. Bleeding in the esophagus, stomach, or duodenum (the first part of the small intestine) are all examples of upper GI bleeding. Lower GI bleeding refers to bleeding in the rectum, anus, and lower small and large intestines. A person may experience bleeding or a hemorrhage that poses a severe risk to their life. Peptic ulcers are commonly caused by a bacterial infection (Helicobacter pylori), nonsteroidal anti-inflammatory drugs (NSAIDs), and low-dose aspirin (LDA).

What Are the Symptoms of Non-variceal Upper Gastrointestinal Bleeding?

Symptoms and signs of non-variceal upper gastrointestinal bleeding can be visible or occult (not visible). The location and pace of the bleeding determine the signs and symptoms, as mentioned below.

• Visible Bleeding May Manifest As:

  • Vomiting blood may be scarlet or dark brown and have a consistency similar to coffee grounds.

  • The patient will pass a dark stool. Dark color due to the presence of blood in the stool.

  • Bleeding from the rectus is commonly seen in stools.

• Occult Bleeding Manifests As:

  • A person will feel unexplained lightheadedness and dizziness

  • Having trouble breathing

  • The patient will experience sudden fainting

  • Severe excruciating chest pain

  • The person will experience unexplained abdominal pain

• Symptoms of Shock:

  • In case of excessive bleeding, the low blood supply to different tissues in the body may lead to shock.

  • Symptom of shock manifest as follows:

    • A persistent decline in blood pressure

    • Not peeing or just urinating rarely and in small amounts

    • A fast heartbeat is also known as tachycardia

    • In a severe case, the person will feel unconscious

What Causes a Non-variceal Upper Gastrointestinal Bleeding?

• Stomach Ulcer or Peptic Ulcer: This is the most typical reason for upper GI bleeding. Stomach acid affects the lining due to infection or anti-inflammatory medicines, resulting in the development of sores. The lining of the stomach and upper small intestine might get lesions called peptic ulcers.

• Mallory-Weiss Tears: When tears or cracks develop in the esophagus lining, a condition known as Mallory-Weiss tears. The condition leads to bleeding from the esophagus. The majority of those who consume alcohol excessively suffer from this.

• Esophageal Varices: In this condition, esophageal veins become enlarged and abnormal. The majority of individuals with severe liver disease experience this illness.

• Esophagitis: The most common cause of this esophageal irritation is gastroesophageal reflux disease (GERD).

• Duodenitis and Gastritis: Duodenitis is an inflammation of the small intestine, whereas gastritis is a stomach infection. Other circumstances, such as excessive use of alcohol, anti-inflammatory drugs, and helicobacter pylori bacterial infection, can lead to the development of both.

• Upper Gastrointestinal Tumors: Bleeding may result from esophageal, stomach, and small intestine cancer. Depending on where they are, pancreatic tumors can occasionally lead to gastrointestinal bleeding.

How Is Non-variceal Upper Gastrointestinal Bleeding Diagnosed?

A doctor may carry out the following tests to identify non-variceal upper gastrointestinal bleeding and determine its cause:

• Endoscopy: It is most frequently used to diagnose upper gastrointestinal bleeding. A short, flexible endoscopic tube is inserted down the patient's throat, equipped with a tiny camera. The upper gastrointestinal tract is then traversed with the scope.

• Enteroscopy: This procedure is carried out if endoscopy is unsuccessful in eliciting the reason for the bleeding. Similar to an endoscope, an enteroscopy differs in that the camera-tipped tube frequently has a balloon attached to it. This balloon can be inflated inside to allow proper visualization.

How Is Non-variceal Upper Gastrointestinal Bleeding Treated?

• Endoscopy:

  • The mainstay of investigation and treatment is endoscopy. Endoscopy enables therapeutic intervention and biopsy while also enabling visualization of the cause of bleeding.

  • Endoscopy is performed under general anesthesia in the operating room, where the airways (path from where air passes) can be maintained to prevent aspiration.

  • Pre-endoscopic erythromycin is thought to boost the initial endoscopy's diagnostic output. Only actively bleeding lesions, non-bleeding visible vessels, and, if technically possible, ulcers with an adherent blood clot require endoscopic therapy.

• Radiological Embolization:

  • Severe bleeding that cannot be controlled with endoscopy or conservative measures requires transcatheter arterial embolization (TAE).

  • In the procedure, the bleeding artery is embolized (blocked). The benefits include avoiding surgery.

  • It is advisable for high-risk patients who are unsuitable for surgery.

  • It is used to treat advanced malignant (cancerous) gastric ulcers and treat occult bleeding that is not visible.

  • Hemostatic (stop bleeding) materials like metal coils, oxidized cellulose, gel foam, or polyvinyl alcohol embolize the bleeding artery. Endovascular embolization is the better method to employ.

  • TAE is an effective first-line treatment for refractory (cases which do not respond to treatment) NVUGIB. Additionally, selective infusion of vasopressin (a drug that can stop bleeding) can reduce bleeding in the local circulation via the left stomach artery.

• Surgery:

  • Despite recent developments in medicinal, endoscopic, and interventional radio-embolization, refracted (do not respond to treatment) cases need surgical intervention to stop bleeding.

  • Surgical intervention is necessary when endoscopic techniques cannot adequately manage the bleeding or the patient becomes unstable during the initial bleeding.

  • Surgery principles include the quickest and safest procedure to stop the bleeding, followed by proton pump inhibitors (PPI) and helicobacter pylori eradication therapy.

  • In most cases, intensive medical treatment combined with a general basic suture to control the bleeding proved sufficient.

What Are the Complications Associated With Non-variceal Upper Gastrointestinal Bleeding?

Serious complications develop if the condition is left untreated. These include respiratory distress, a heart attack, infection, shock, death, and intestinal perforation.

Conclusion:

Bleeding that appears in the esophagus, stomach, or proximal duodenum is referred to as non-variceal upper gastrointestinal bleeding (NVUGIB). A common cause of peptic ulcer disease is Helicobacter pylori infection, followed by NSAIDs and low-dose aspirin. Despite significant improvements in NVUGIB prevention and management, the incidence and mortality of NVUGIB have declined. However, it is still a frequent clinical issue. The NVUGIB has a minor mortality rate in a medical emergency. After resuscitation and initial evaluation, the foundation of treatment is early (within 24 hours) diagnostic and therapeutic endoscopy, along with intragastric pH control with drugs such as proton pump inhibitors (PPIs).