Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is a symptom of a disorder in the digestive tract from the mouth to the anus. The blood often appears in stool or vomit but isn't always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and can be life-threatening.

GI bleeding is a symptom of a disease or condition, rather than a disease or condition itself.

Sophisticated imaging technology, when needed, can usually locate the cause of the bleeding. Treatment depends on the source of the bleeding.

Symptoms

Signs and symptoms of GI bleeding can be either obvious (overt) or hidden (occult). Signs and symptoms depend on the location of the bleed, which can be anywhere on the GI tract, from where it starts — the mouth — to where it ends — the anus — and the rate of bleeding.

• Overt bleeding might show up as:
  • Vomiting blood, which might be red or might be dark brown and resemble coffee grounds in texture
  • Black, tarry stool
  • Rectal bleeding, usually in or with stool
• Occult bleeding may result in:
  • Lightheadedness
  • Difficulty breathing
  • Fainting
  • Chest pain
  • Abdominal pain

Symptoms of shock

If bleeding starts abruptly and progresses rapidly, shock could result.

Signs and symptoms of shock include:

• Drop in blood pressure
• Not urinating or urinating infrequently, in small amounts
• Rapid pulse
• Unconsciousness

Gastrointestinal bleeding can occur either in the upper or lower gastrointestinal tract. It can have a number of causes.

Upper GI bleeding

• Causes can include:
  • Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining of the stomach and upper portion of the small intestine. Stomach acid, either from bacteria or use of anti-inflammatory drugs, damages the lining, leading to formation of sores.
  • Tears in the lining of the tube that connects your throat to your stomach (esophagus). Known as Mallory-Weiss tears, they can cause a lot of bleeding. These are most common in people who drink alcohol to excess.
  • Abnormal, enlarged veins in the esophagus (esophageal varices). This condition occurs most often in people with serious liver disease.
  • Esophagitis. This inflammation of the esophagus is most commonly caused by gastroesophageal reflux disease (GERD).
  • Gastritis
  • Crohn’s disease
  • Liver cancer
  • Pancreatic cancer
  • Stomach cancer

Lower GI bleeding

Causes can include:

• Diverticular disease. This involves the development of small, bulging pouches in the digestive tract (diverticulosis). If one or more of the pouches become inflamed or infected, it's called diverticulitis.
• Inflammatory bowel disease (IBD). This includes ulcerative colitis, which causes inflammation and sores in the colon and rectum, and Crohn's disease, and inflammation of the lining of the digestive tract.
• Tumors. Noncancerous (benign) or cancerous tumors of the esophagus, stomach, colon or rectum can weaken the lining of the digestive tract and cause bleeding.
• Colon polyps. Small clumps of cells that form on the lining of your colon can cause bleeding. Most are harmless, but some might be cancerous or can become cancerous if not removed.
• Hemorrhoids. These are swollen veins in your anus or lower rectum, similar to varicose veins.
• Anal fissures. These are small tears in the lining of the anus.
• Proctitis. Inflammation of the lining of the rectum can cause rectal bleeding.
• Ulcerative colitis
• Colorectal cancer

Diagnosis of GI Bleeding

To diagnose gastrointestinal (GI) bleeding, a doctor will first find the site of the bleeding based on your medical history—including what medicines you are taking—and family history, a physical exam, and diagnostic tests.

• Physical exam: body exam, listen to abdominal sounds and tapping specific areas of the body
• Diagnostic tests: Depends on the symptoms, one or more diagnostic tests to confirm whether you have GI bleeding and, if so, to help find the source of the bleeding. Tests could include:
  • Stool tests—fecal occult blood test
  • Blood tests
  • Gastric lavage
  • Upper GI endoscopy
  • Enteroscopy
  • Capsule Endoscopy
  • Colonoscopy
  • Flexible sigmoidoscopy
• Imaging Tests:
  • Abdominal CT scan
  • Lower GI series
  • Upper GI series
  • Angiogram
  • Radionuclide scan
• Procedures to examine the GI tract
  • Laparotomy
  • Laparoscopy

How common is GI bleeding?

• Every year, about 100,000 people in the United States go to the hospital for upper GI bleeding.1
  • [1] Cerulli M. Upper gastrointestinal bleeding: epidemiology. Medscape website. emedicine.medscape.com External link. Updated March 21, 2016. Accessed July 19, 2016.
• About 20 to 33 percent of GI bleeding episodes in Western countries are in the lower GI tract.2
  • [2] Cagir B. Lower gastrointestinal bleeding: background. Medscape website. emedicine.medscape.com External link. Updated March 29, 2016. Accessed July 19, 2016.

Who is more likely to have GI bleeding?

• Men are twice as likely as women to have upper GI bleeding.3
  • [3] Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. American Journal of Gastroenterology. 1995;90(4):568–573.

Complications
A gastrointestinal bleed can cause:

• Shock
• Anemia
• Death

References & additional reading:

• Mayo Clinic - Gastrointestinal bleeding
• NIH - Gastrointestinal (GI) Bleeding
• Cleveland Clinic - Gastrointestinal (GI) Bleeding