In a patient with coffee-ground emesis and a history of alcohol abuse, what is the most likely cause of upper gastrointestinal bleeding?

In a patient presenting with coffee-ground emesis and a history of alcohol abuse, erosive gastritis is the most likely cause of upper gastrointestinal bleeding. Erosive gastritis refers to the inflammation of the stomach lining that leads to superficial ulcerations and erosion, commonly attributed to factors such as excessive alcohol consumption, medication use (like NSAIDs), and stress. In individuals with a history of alcohol abuse, the harmful effects of alcohol on the gastric mucosa can result in increased susceptibility to these erosive changes and subsequent bleeding.

Coffee-ground emesis indicates that the blood has been in contact with gastric acid for some time, causing it to be altered in appearance. This type of emesis is typical with conditions that lead to bleeding in the stomach, such as erosive gastritis, where the erosion exposes blood vessels that may bleed into the gastric lumen.

Other options like gastric neoplasm, Mallory-Weiss tear, and Zenker diverticulum can also cause gastrointestinal bleeding but are less commonly associated with a straightforward presentation of coffee-ground emesis in the context of chronic alcohol abuse. Gastric neoplasms usually have more indolent symptoms and generally do not present acutely with coffee-ground emesis. A Mallory-Weiss tear is often related to