GERD, Peptic Ulcer Disease & GI Bleeding

GERD (gastroesophageal reflux disease) happens when stomach acid repeatedly flows back into the esophagus because the lower esophageal sphincter is weak. Peptic ulcer disease is a break in the lining of the stomach or duodenum — an open sore — usually caused by H. pylori or NSAID painkillers. GI bleeding is blood loss from the digestive tract, seen as vomiting blood, black tarry stools (melena) or fresh rectal blood.

Chronic reflux can progress to Barrett's esophagus and cancer; ulcers can bleed or perforate suddenly; GI bleeding can kill within hours. All three are common, all have clear alarm features, and early endoscopy plus the right drugs prevent most disasters.

Key Concepts

• GERD: heartburn and regurgitation, worse after meals and lying down. Treated with lifestyle measures and proton-pump inhibitors (PPIs). Alarm features — trouble swallowing, weight loss, bleeding, anemia — demand urgent endoscopy.
• Peptic ulcer causes: H. pylori and NSAIDs (ibuprofen, aspirin) cause the vast majority; excess acid alone rarely does. Diagnosis by endoscopy or H. pylori stool-antigen/urea breath test.
• Ulcer complications: bleeding, perforation (sudden severe pain with a rigid abdomen — surgical emergency) and gastric outlet obstruction from scarring.
• Ulcer treatment: H. pylori eradication with triple therapy (PPI + clarithromycin + amoxicillin, 14 days), stopping NSAIDs, and PPIs to heal.
• GI bleed sources: upper bleeds cause hematemesis and melena — usually ulcers, varices or Mallory-Weiss tears. Lower bleeds cause hematochezia — diverticula, piles, colitis.
• Resuscitation first: two large-bore IV lines, monitoring, blood grouping and transfusion — before endoscopy. The Glasgow-Blatchford score predicts who needs urgent intervention; a score of 0 marks very low risk.

Formulas

• Glasgow-Blatchford score (admission risk): add points — urea 6.5–8 mmol/L: 2, 8–10: 3, 10–25: 4, over 25: 6; hemoglobin (men) 12–13 g/dL: 1, 10–12: 3, under 10: 6 (women 10–12: 1, under 10: 6); systolic BP 100–109: 1, 90–99: 2, under 90: 3; pulse at or above 100: 1; melena: 1; syncope: 2; liver disease: 2; cardiac failure: 2. Higher totals mean higher risk of needing intervention.

Worked Example

1. A 60-year-old man vomits blood and passes black stools. Labs: urea 9 mmol/L, hemoglobin 11 g/dL; vitals: BP 105/70, pulse 105; he fainted briefly (syncope) with melena on exam.
2. Blatchford points: urea 9 (8–10 band) = 3; Hb 11 in a man (10–12 band) = 3; systolic 105 (100–109) = 1; pulse 105 (≥100) = 1; melena = 1; syncope = 2. Total = 3 + 3 + 1 + 1 + 1 + 2 = 11.
3. A score of 11 is high risk, so he is resuscitated, grouped for transfusion, started on a PPI infusion and taken for urgent endoscopy, which clips a bleeding duodenal ulcer.

Common Misconceptions

• Myth: Spicy food causes ulcers. Fact: H. pylori and NSAIDs cause them; spice only irritates an existing ulcer.
• Myth: Black stools always mean bleeding. Fact: iron tablets and bismuth also blacken stool — but true melena is tarry and foul, and needs checking.
• Myth: Antacids cure GERD. Fact: they neutralize acid for an hour or two; healing the esophagus needs PPIs plus lifestyle change.

Real-World Applications

• Primary care: test-and-treat for H. pylori prevents ulcers before they bleed.
• Emergency endoscopy: banding varices and clipping ulcers stops bleeding at the source.
• Pharmacy counseling: NSAID users learn about ulcer risk and protective co-prescription.

GERD is acid reflux managed with PPIs and lifestyle; peptic ulcers come from H. pylori and NSAIDs and are cured by eradication therapy; GI bleeding is resuscitated first and risk-stratified with the Glasgow-Blatchford score; 11 points means urgent endoscopy. Alarm features in any of the three deserve a scope.