Acute hemorrhagic gastritis

Acute hemorrhagic gastritis is an important cause of upper gastrointestinal bleeding, accounting for approximately one fourth of UGI bleeding in endoscopic studies. Most patients with hemorrhagic gastritis have underlying predisposing conditions, such as alcohol abuse, portal hypertension, short- or long-term NSAID use, and physiologic stress associated with hospitalization in an ICU for severe life-threatening disease or trauma. The key to management is prevention; however, once established, hemorrhagic gastritis is treated with both supportive measures and measures directed toward healing the mucosal damage. In general, therapy is the same as that for classic peptic ulcer disease. These patients present a challenge, however, because of their underlying diseases and because of the potential for diffuse mucosal bleeding, the latter making the use of endoscopic therapy more difficult. Surgery is an option of last resort for the patient who continues to bleed despite aggressive medical and endoscopic therapy. Future investigations will focus on pharmacologic therapy to enhance mucosal defense mechanisms, therapy that will likely attain increasing importance in the years to come.