Varices are the most common cause of bleeding from the oesophagus and make-up almost 30% of the causes responsible for upper GI bleeds. It should be kept in mind that upper GI bleeds are most commonly as a result of gastric diseases. When it comes to Oesophageal causes, varices are the most common. Oesophagitis can also sometimes present with haematemesis and oesophageal carcinoma only rarely presents with bleeding, its important associated symptom being dysphagia, not bleeding.
The main symptom of Oesophagitis is odynophagia, although it can present with bleeding. It is common in immunosuppressed individuals and its causative organisms include:
Why does oesophagitis causes bleeding?
When inflammation is too severe, ulcers develop and these cause bleeding. Constant bleeding causes irritation of the oesophageal mucosa (blood is an irritant when outside the blood vessels) due to which vomiting occurs and the extruded blood appears in the vomitus.
The main symptom is dysphagia, not upper GI bleeding. However, when ulceration of the mucosa is severe due to invasion by the cancer cells, bleeding ensues. This is an extremely advanced stage of disease and the dysphagia, which appears far earlier than the haematemesis, is severe enough to force the patient to see a doctor.
To sum up, oesophageal varices are the only cause added from amogst the oesophageal conditions to the list of the most common causes of haematemesis, which include: peptic ulcer, gastritis and oesophageal varices. However, keeping oesophagitis and oesophageal carcinoma in mind is also important.
- Barrett’s patients who smoke twice as likely to develop oesophageal cancer (eurekalert.org)
- When I Die: Lessons from the Death Zone by Philip Gould – review (guardian.co.uk)