Investigation of chronic upper gastrointestinal haemorrhage.

Acute haemorrhage from the upper alimentary tract is a common cause of emergency admission to hospital, and in about 80% of these patients the condition causing the bleeding will be an acute haemorrhagic gastritis or a chronic gastric or duodenal ulcer. The diagnosis in this group ofpatients will be confirmed by early endoscopic examination in about 90% of patients. A small proportion of these patients will go on to have recurrent episodes of haemorrhage over a period of months or years, leading to chronic blood loss and in many the diagnosis of the underlying cause of bleeding will be elusive. In addition, there are some lesions in the upper alimentary tract which will give rise to low grade chronic or occult bleeding and the presenting features will be those of chronic anaemia. Patients with chronic upper alimentary blood loss may be suffering from a very wide range of pathological conditions, some of them quite rare; the diagnostic challenge to the clinician may be great.