Gastric Bleeding: Recognizing Symptoms and Providing First Aid

What is Gastric Bleeding and Why is it Dangerous?

Acute gastrointestinal bleeding (GIB) is one of the most frequent and dangerous conditions requiring emergency medical care. Its prevalence and mortality remain significant despite some improvements [2]. Upper GI bleeding is a major cause of blood transfusions and in-hospital mortality [5].

The most common causes of acute upper GI bleeding are gastric and duodenal ulcers (about 56.5% of cases) and esophageal varices (approximately 25.4% of cases) [5]. Timely diagnosis and prompt treatment are critical for improving outcomes [2].

How to Recognize Gastric Bleeding: Main Symptoms

Symptoms of gastric bleeding can range from subtle to life-threatening:

• Vomiting blood (hematemesis): Blood may be bright red or have a "coffee-ground" appearance (dark clots), indicating the interaction of blood with gastric juice [3].
• Severe epigastric pain: Sudden, intense pain in the upper abdomen, sometimes radiating to the right upper quadrant, can be a sign of bleeding or ulcer perforation [1, 3].
• Signs of shock: Blood loss leads to a drop in blood pressure and an increased heart rate [4]. The patient experiences weakness, dizziness, paleness, and cold sweat. Severe anemia often develops (hemoglobin less than 7 g/dL) [5].
• Symptoms of perforation: Ulcer perforation manifests as sudden "dagger-like" abdominal pain and the presence of free air in the abdominal cavity (pneumoperitoneum) [1, 6]. Pneumoperitoneum is detected on chest X-rays in the majority of patients [6].

Important: similar symptoms (coffee-ground vomiting, epigastric pain) can mask acute myocardial infarction, especially in patients with cardiovascular risk factors [3].

Causes of Gastric Bleeding and Risk Factors

Gastric bleeding is most often a complication of gastrointestinal diseases or the result of certain factors:

• Peptic ulcer disease: Gastric and duodenal peptic ulcers are the most common cause of bleeding (56.5% of cases) and the main cause of mortality [5]. Ulcer perforation also frequently requires emergency hospitalization [6].
• Esophageal varices: The second most common cause of bleeding (25.4% of cases), more frequently leading to recurrent bleeding [5].
• NSAID use: 36.2% of patients with acute bleeding report taking nonsteroidal anti-inflammatory drugs, which can damage the gastric mucosa [5].
• Alcohol abuse: Frequent alcohol consumption is noted in 43.5% of patients with acute bleeding [5].
• Hollow organ rupture: Can lead to bleeding and pneumoperitoneum [1].
• Rare complications: Barium-associated intestinal ischemia following gastrointestinal X-ray examination is extremely dangerous if intestinal necrosis develops [4].

First Aid for Suspected Gastric Bleeding

Gastric bleeding is an emergency condition requiring immediate medical assistance. Proper actions before doctors arrive can save a life:

1. Call an ambulance immediately: Clearly describe the symptoms to the dispatcher.
2. Position the patient: Lie them flat with elevated legs to improve brain blood supply and reduce symptoms of shock.
3. Ensure rest: Any physical activity can increase bleeding.
4. Do not give food or drink: It is strictly forbidden to give any food or liquid, as this can provoke increased bleeding or vomiting.
5. Apply cold to the abdomen: Use an ice pack or a cold heating pad wrapped in cloth and apply it to the epigastric area. Cold helps constrict blood vessels.
6. Do not give any medications: Do not administer painkillers or other medications without a doctor's prescription to avoid worsening the situation and complicating diagnosis.

Emergency triage systems are important, but patients with perforated ulcers or bleeding may be underestimated at the pre-hospital stage [7].

Hospital Diagnosis and Treatment

In the hospital, the priority task is to stabilize the patient and identify the source of bleeding.

Diagnosis:
• Examination and anamnesis: Assessment of condition, looking for signs of hemorrhagic shock [2].
• Laboratory tests: Hemoglobin levels, coagulation parameters.
• Endoscopy: The primary method for diagnosing and treating acute upper GI bleeding. It allows visualization of the source, assessment of activity, and performance of hemostasis [2, 5]. Successful in 87% of cases [5].
• Ultrasound, radiography, CT: If perforation or pneumoperitoneum (free air in the abdominal cavity) is suspected, ultrasound, chest radiography, and CT are used [1]. Ultrasound can reveal characteristic signs of free air [1].
• ECG and troponins: When atypical symptoms mimic bleeding, myocardial infarction must always be considered, requiring an ECG and troponin analysis [3].
Treatment:

Depends on the cause and severity of the bleeding:

• Condition stabilization: Intravenous fluid administration to restore blood volume and, if necessary, blood transfusion [1].
• Endoscopic hemostasis: Vasoconstrictor injections, thermal coagulation, vessel clipping [5].
• Drug therapy: Medications that reduce stomach acidity (proton pump inhibitors) and other agents as indicated.
• Antibiotic therapy: Broad-spectrum antibiotics are prescribed for hollow organ perforation [1].
• Surgical intervention: Emergency surgery may be required for massive, uncontrolled bleeding, ulcer perforation, or other complications [1, 6].

Early risk assessment, timely endoscopy, and correction of reversible factors (e.g., NSAID use, alcohol abuse) are crucial [5].

Sources

1. A-Lines below the Diaphragm - A Case Report of Occult Pneumoperitoneum. (Journal of Education and Teaching in Emergency Medicine, 2026)
2. Acute Gastrointestinal Bleeding: An Update and a Practical Diagnostic Approach. (Diagnostics (Basel, Switzerland), 2026)
3. Vomiting Blood, Missing the Heart: A Rare Presentation of Acute Myocardial Infarction. (Cureus, 2025)
4. Barium-associated intestinal ischemia complicated with massive hepatic portal venous gas: A successful survival case report. (The Journal of International Medical Research, 2026)
5. Predictors of mortality and rebleeding in acute upper gastrointestinal bleeding: A prospective hospital-based study. (Bioinformation, 2026)
6. A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria. (International Medical Research Notes, 2017)
7. Prehospital triage of patients diagnosed with perforated peptic ulcer or peptic ulcer bleeding: an observational study of patients calling 1-1-2. (Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2018)

Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional consultation, diagnosis, or treatment by a qualified medical specialist. If any alarming symptoms appear, consult a doctor immediately.