 Hello friends, I am Dr. Kunal Das and I am consultant and head of the department, Department of Gastroenterology at Manipal Hospital, Dwarka. Today, we are going to talk about a very important issue of upper GI bleed or commonly known as blood in vomiting or it is also known as hematomasis. In this disease, the person vomits out blood from the mouth and it is a very dreaded disease. The most common causes of upper GI bleed in India are first, Peptic ulcer disease, which is both can be either doodernal ulcer or gastric ulcer. Second most common is varicill bleed. Third most common is due to portal gastropathy. Fifth, fourth is due to malaria vestiae. These are the most common causes of upper GI bleed in India and we will take one by one. The most important cause is due to ulcer. Ulcer as we know it is a damage to the stomach or the doodernal epithelium and which causes the blood to ooze. It can become very dangerous. The most common causes of ulcer are either alcohol, painkillers and in certain diseases like chronic liver disease, chronic kidney disease, etc. The second most common cause of upper GI bleed in Indian scenario are varicill bleed. Varicis are nothing but dilated veins in the esophagus which because of the increased pressure and liver damage rupture and the bloods come out and that is why the patient bleeds from the mouth. So it is a very important cause of liver disease and the sign of liver disease. The third most common is due to portal gastropathy. It is a diffuse ooze from the stomach. Then it occurs due to presence of liver disease which can be due to alcohol or some viruses like hepatitis B, hepatitis C, certain diseases like diabetes and hypothyroidism and thyroid which can cause what is called as non-alcoholic state of hepatitis. So what are the things? How do we diagnose the upper GI bleed? We do certain things, the patient needs to be immediately taken to the hospital emergency. There the hospital emergency doctor will start some IV fluids, normal line, do the emergency management and resuscitation of the patient in the emergency and then might need to shift the patient to the ICU. Sometimes the patient has a very low BP and a very high tachycardia. These are signs of a very serious damage to the upper GI bleed and such patients needs to be admitted in the hospital. Also the most important tests are CBC hemoglobin and the ultrasound of the abdomen and there is a very important test known as upper GI endoscopy. Upper GI endoscopy is nothing but a test where there is a flexible tube pipe which has a light and a camera attached to the distal end of the tube which goes through the mouth above the tongue into the food pipe, stomach and duodenum and it can see what is causing upper GI bleed. This is the single most important test for finding out the reason for upper GI bleed. So once this patient goes into the ICU, a gastroenterologist or an endoscopist who is expert for endoscopy will conduct this test on your patient. This test can be conducted under local anesthesia and does not take more than 2-5 minutes. So we will know if there is an ulcer, what kind of ulcer, the number of ulcers, whether it is actively bleeding or actively oozing. If there is actively bleeding, we have several methods to control the bleeding. Like we do endoscopic sclerotherapy which is by a special needle we inject injection adrenaline into the base of the ulcer to stop it from bleeding. Also at Manipal we have several new advanced techniques like hemoclipic where we have a special clip which is a modified version of a ladies hair clip which goes to the endoscope and mechanically stops the blood. We have also a very good method of thermal gold probe which can touch the ulcer and coagulate the artery which is causing the bleed. Also we have today special hemostatic powders which were earlier used in US Army for stoppage of blood. We have today available in our endoscopy rooms at Manipal Hospital where we can spray the blood and stop the blood immediately. The second most common is the varicillate bleed where we see the veins. We have several techniques to tackle the varicillate bleed also. The most important technique is known as endoscopic varicillation which is a special type of bands which we apply on the veins. These are like ladies hair bands. These are applied on the isovigil veins and the isovigil veins stops the blood and gradually the bands peel off and it causes fibrosis thus blocking the vein into a fibrous band hence because the blood cannot flow there is no bleed. So these are the emergency techniques which are available today in the armamentarium of a gastroenterologist to control the bleed very essential. Few years ago such patients would be highly morbid and mortality causing almost 20 to 30 percent mortality. But with the advancement of sciences specialized medicine specialized endoscopy procedures the death rate in such patients have been reduced to less than 10 percent. My worry to the friends is whenever any of your family members or friends has any upper GA bleed please do not ignore because anywhere blood in anywhere from the body is an abnormal thing and also is an indicator for a disease. Please take him to a right person and to a emergency where they are doctors who will attend to the patient. Also it is important to take certain precautions that we can take in our daily life to prevent the pain to prevent this upper GA bleed from happening to you because the most common is ulcer. So we can avoid alcohol and smoking these two are very important causes of ulcer bleed. Also we should stop taking indiscriminately NSA's or painkillers we today have any pain and we can just go to the chemist or we ask the chemist to give us painkillers please do not take very do not misuse the use of painkillers go to the doctor doctor will tell you when to take the painkillers and doctor might prescribe you painkillers which are safe for your abdomen stomach and which does not cause upper GA bleed. So it is important to take a medical advice before you pop in a pill. The third thing which is important is that you should also decrease taking consumption of alcohol. The lifestyle is very important the younger generation is very happily consumes a lot of alcohol. So this also is a important cause of ulcers as well as it causes liver disease. So we have to be careful have a good lifestyle and we should take good fruits vegetables have a good lifestyle so that we can prevent the upper GA bleed from happening. Thank you very much.