| Peptic Ulcer Disease (PUD) |
- History of NSAIDs, steroids, or alcohol use.
- H. pylori infection causes ↑ acid + ↓ mucosal defences → ulceration.
- Erosion into an artery can cause brisk haematemesis.
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- Burning epigastric pain, relieved by food/antacids.
- Melena or haematemesis.
- Features of anaemia if chronic bleeding.
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- Upper GI endoscopy (diagnostic + therapeutic).
- H. pylori testing (breath, stool, biopsy).
- FBC for Hb drop.
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- Resuscitation (fluids, blood if needed).
- IV PPI, H. pylori eradication if positive.
- Endoscopic therapy: clipping, injection, coagulation.
- Surgery if refractory.
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| Oesophageal Varices |
- History of alcohol misuse, hepatitis, or cirrhosis.
- Portal hypertension → dilated submucosal veins at GOJ.
- High risk of massive bleeding when ruptured.
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- Massive haematemesis, often with shock.
- Stigmata of liver disease: jaundice, ascites, spider naevi.
- Splenomegaly, easy bruising (coagulopathy).
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- Endoscopy (diagnostic + therapeutic).
- LFTs, INR, albumin.
- Ultrasound/Doppler → cirrhosis, portal hypertension.
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- ABC resuscitation, correct coagulopathy.
- IV terlipressin or octreotide.
- Prophylactic antibiotics (cirrhotic patients).
- Endoscopic band ligation/sclerotherapy.
- TIPS or transplant for refractory bleeding.
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| Mallory–Weiss Tear |
- History of repeated retching/vomiting after binge drinking, pregnancy, or bulimia.
- Mucosal tear at GOJ from sudden ↑ intra-abdominal pressure.
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- Acute haematemesis following forceful vomiting.
- Usually self-limiting bleeding.
- Mild epigastric discomfort.
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- Endoscopy shows linear mucosal tear at GOJ.
- FBC for anaemia.
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- Supportive: IV fluids, PPIs.
- Endoscopic therapy if bleeding persists.
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| Gastritis / Gastropathy |
- NSAIDs, alcohol, bile reflux, stress (critically ill).
- Pathophysiology: mucosal inflammation → erosion of superficial vessels.
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- Epigastric pain, nausea, vomiting.
- Haematemesis if erosive.
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- Endoscopy: erythema, erosions, haemorrhage.
- H. pylori testing.
- FBC.
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- PPIs, stop NSAIDs, alcohol cessation.
- H. pylori eradication if positive.
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| Oesophagitis |
- History of GORD, pill injury, caustic ingestion.
- Acid reflux damages mucosa → erosions/ulceration.
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- Heartburn, dysphagia, regurgitation.
- Haematemesis if severe erosive disease.
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- Endoscopy for mucosal changes.
- Barium swallow sometimes used.
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- PPIs, lifestyle changes.
- Treat cause (stop offending drug, manage reflux).
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| Malignancy (Oesophageal / Gastric) |
- History of smoking, alcohol, GORD, H. pylori, family history.
- Tumour erosion into blood vessel → bleeding.
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- Progressive dysphagia, weight loss, anorexia.
- Haematemesis or melena in advanced cases.
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- Endoscopy + biopsy (diagnosis).
- CT for staging.
- FBC for anaemia.
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- Surgical resection if operable.
- Chemotherapy/radiotherapy depending on stage.
- Palliative care for advanced disease.
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