Which histologic findings are characteristic of upper GI bleeding (UGIB)?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

In patients with gastric ulcers, the bleeding vessel lies in the deepest layer of the ulcer. Fibrinoid necrosis is observed at the site of perforation of the vessel. Pseudoaneurysmal dilatation of the vessel may be present at the site of perforation. Biopsy samples should be taken from the edge of a gastric ulcer to rule out carcinoma.

The characteristic lesion of H pylori is chronic active gastritis with the organisms observed after routine staining. The lesion of gastric antral vascular ectasia is capillary dilation with fibrin clots and fibromuscular hyperplasia.

However, histologic findings may not offer clinically relevant information in the initial management of upper gastrointestinal (GI) bleeding (UGIB), in part due to the delay in processing of pathologic specimens from the time of the initial esophagogastroduodenoscopy (EGD) and endoscopic biopsies.

Previous reports have noted a decreased sensitivity of biopsies for H pylori during acute GI bleeding, presumed to be due to the buffering effects of blood. [117, 118]  This was primarily for the rapid urease testing. However, histology is not affected by the presence of blood at endoscopy in the diagnosis of H pylori. [119]


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