Gastrointestinal Bleeding in Severe Acute Pancreatitis: Pathogenesis and Clinical Management

Severe acute pancreatitis (SAP) is associated with a broad spectrum of local and systemic complications, among which gastrointestinal bleeding (GIB), although relatively uncommon, confers a disproportionately high mortality risk. The underlying pathogenic mechanisms remain incompletely elucidated and are distinctly multifactorial, involving acute gastric mucosal lesions, stress-induced ulcers, esophageal and gastric varices, and pseudoaneurysm formation and rupture. This review aims to systematically synthesize current evidence on the pathogenesis of SAP-associated GIB, thereby informing the development of targeted intervention strategies, improving the precision of individualized therapeutic decision-making, and ultimately providing a robust theoretical basis to optimize patient outcomes.