History. It is needed to remember, that anamnesis is very important for diagnosis

It is needed to remember, that anamnesis is very important for diagnosis. The patient history findings include weakness, dizziness, syncope associated with haematemesis (coffee ground vomitus), melena (black stools with a rotten odour) and haematochezia (red or maroon stool).

More patients tell about their peptic ulcer disease. Sometimes bleeding has occurred repeatedly or patients have undergone surgery for perforated ulcer in the past. In some patients a gastric or duodenum ulcer was not diagnosed before and correctly collected anamnesis revealed that the patient had stomach ache. Patients often tell that pain in upper part of abdomen which occurred a few days prior to bleeding, suddenly disappears the onset of bleeding (Bergmann’s sign).

Patients may have a history of previous dyspepsia (especially nocturnal symptoms), ulcer disease, early satiety, and NSAID or aspirin use. Many patients with peptic ulcer acute haemorrhage who are taking nonsteroidal anti-inflammatory drugs present without dyspepsia but with haematemesis or melena as their first symptom. Low-dose aspirin (81 mg) has been associated with peptic ulcer acute haemorrhage with or without the addition of NSAID therapy. Patients with a prior history of ulcers are at an especially increased risk for peptic ulcer acute haemorrhage when placed on aspirin or NSAID therapy and should receive continuous acid suppression with a proton pump inhibitor. Because recurrence of ulcer disease is common, history findings are relevant.

Patients may present in a more subacute phase with a history of dyspepsia and occult intestinal bleeding manifesting as a positive faecal occult blood test result or as iron deficiency anemia.

A history of recent aspirin ingestion suggests that the patient may have nonsteroidal anti-inflammatory drug gastropathy with an enhanced bleeding diathesis from poor platelet adhesiveness.

A history of chronic alcohol use of more than 50 g/d or chronic hepatitis (B or C) increases the risk of haemorrhage, gastric antral vascular ectasia, or portal gastropathy.

The presence of postural hypotension indicates more rapid and severe blood loss.