The causes of hematemesis and melena in cirrhosis

The causes of hematemesis (vomiting blood) and melena (black tarry stools) in patients with cirrhosis are primarily attributed to portal hypertension and gastrointestinal lesions. First, cirrhosis leads to portal hypertension, resulting in esophageal and gastric varices; once these varices rupture, they can cause massive upper gastrointestinal bleeding. This is the most common cause, accounting for 60% to 75% of all major upper gastrointestinal hemorrhages in cirrhotic patients. Second, peptic ulcers—including gastric and duodenal ulcers—may also lead to bleeding, representing 15% to 30% of cases, and typically manifest as melena. Third, portal hypertensive gastropathy accounts for 10% to 20% of bleeding episodes, which also predominantly presents as melena. Additionally, other conditions such as reflux esophagitis, esophageal cancer, gastric cancer, and biliary tract diseases may also contribute to gastrointestinal bleeding. Together, these factors create a complex clinical picture underlying hematemesis and melena in patients with cirrhosis.