## Epidemiology of Upper GI Bleeding **Key Point:** Peptic ulcer disease (PUD) remains the leading cause of upper GI bleeding in India and most developing countries, accounting for 40–60% of cases. ### Common Causes of Upper GI Bleeding | Cause | Frequency | Key Feature | |-------|-----------|-------------| | Peptic ulcer disease | 40–60% | Most common; related to H. pylori and NSAIDs | | Variceal bleeding | 15–20% | Portal hypertension; high mortality | | Mallory-Weiss tear | 5–15% | Mucosal tear after forceful vomiting | | Gastric erosions | 5–10% | Stress-related or NSAID-induced | | Dieulafoy lesion | 1–2% | Rare; arteriovenous malformation | | Boerhaave syndrome | <1% | Esophageal perforation; medical emergency | **High-Yield:** In the Indian population, H. pylori seropositivity is 40–50%, making PUD the dominant cause of non-variceal upper GI bleeding. NSAIDs are the second major risk factor. **Clinical Pearl:** Variceal bleeding, though less common overall, carries the highest mortality (30–50%) and requires urgent endoscopic therapy with vasoactive drugs. ### Why PUD Leads 1. High H. pylori prevalence in India 2. NSAID use for pain relief (often over-the-counter) 3. Chronic inflammation of gastric/duodenal mucosa 4. Ulcer erosion into blood vessels → bleeding **Mnemonic:** **DUMB** causes of upper GI bleeding (in order of frequency): - **D**uodenal/gastric ulcers (peptic ulcer disease) - **U**pper esophageal varices - **M**allory-Weiss tear - **B**oerhaave syndrome [cite:Harrison 21e Ch 297]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.