Upper Gastrointestinal bleeding (UGIB) affects approximately 1 in 1000 of the population per year and has an overall mortality of up to 10%.
The cause of the UGIB in the patient in front of you may not be known, however a targeted history related to medication and alcohol use, can help with making a diagnosis in the undifferentiated patient. Ulcers are the most common cause of UGIB and they may be secondary to H. pylori infection or NSAID use. Clinically it may be difficult to distinguish them from gastric erosions, which are mostly related to alcohol and NSAID use. Other causes of UGIB include mucosal tears (Mallory-Weiss tear)which are usually associated with vomiting and gastric cancers. In patients with alcoholic liver disease and portal hypertension, we need to be suspicious that this is a variceal bleeds.