Non peptic ulcer associated gastric bleeding

Non peptic ulcer associated gastric bleeding 

Updated: 02/17/2021

© Jun Wang, MD, PhD

Stress related mucosal disease
  • AKA stress-related erosive syndrome, stress ulcer syndrome, and stress-induced gastritis
  • Associated with critical illness or extreme physiologic stress
  • GI blooding due to ulcer
Curling ulcers: Proximal duodenum, associated with severe burns or trauma
Cushing ulcers: Gastric, duodenal, and esophageal, associated with intracranial disease, likely perforate
  • Most likely associated with local ischemia, due to either systemic hypotension, local vasoconstriction 
  • May be associated with overproduction of gastric acid due to vagal activation 
  • Presentations: GI bleeding, such as coffee ground vomitus, melena
  • Sharply demarcated, multifocal, NO scarring
  • Diagnosis: Clinical presentations, laboratory findings, endoscopic examination
  • Management: Prophylaxis of stress gastritis using proton pump inhibitors, etc
Dieulafoy lesion
  • Relatively rare, but potentially life-threatening
  • More common in men
  • Unknown etiology and triggering factors
  • Rupture or erosion of a submucosal vascular malformation, most common along the lesser curvature
  • Treatment: Stop bleeding (electrical current, argon gas, etc)
Gastric antral vascular ectasia (Watermelon stomach)
  • Rare
  • Etiology unclear
  • Associated with connective tissue diseases, particularly systemic sclerosis
  • More common in elder women
  • Dilated vessel with fibrin thrombi, fibromuscular hyperplasia and reactive gastropathy
  • Chronic bleeding may cause iron deficiency anemia
  • Treatment: Laser/plasma coagulation, treatment of iron deficiency anemia



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