Upper gastrointestinal bleeding in patients with portal hypertension: a reappraisal

The current medical literature states that upper gastrointestinal bleeding in patients with cirrhosis and portal hypertension originates from a variety of sources. Although variceal bleeding has been recognized as the principal source, acute erosive gastritis and peptic ulcer are said to be the bleeding site in a large percentage of cases. In 140 consecutive patients with endoscopically documented esophageal varices who came to our service with upper gastrointestinal hemorrhage, varices were the source of bleeding in approximately 90%, regardless of whether the underlying liver disease was due to alcoholism or not. We conclude that: 1) patients with varices almost always bleed from varices, and 2) the incidence of erosive gastritis and peptic ulcer as a cause of bleeding in this group has been overemphasized.