An Overview of Gastrointestinal Tract Bleeding

Many times, gastrointestinal tract bleeding is not serious, such as in the case of hemorrhoids. However, some bleeds, particularly those that occur in the upper GI tract, can be large and fatal.

Therefore, it is very important to be evaluated by a healthcare provider for any GI bleeding, and if someone has any of the symptoms of an acute bleed, they should seek emergency treatment immediately.

Bleeding in the digestive tract is not a disease, but rather a symptom of disease. The cause of bleeding may be related to a condition that can be cured, or it may be a symptom of a more serious condition.

Gastrointestinal Bleeding Symptoms

What symptoms you have depends on which area of the digestive tract the bleeding occurs in, and whether bleeding is acute (brief and possibly severe) or chronic (long duration).

Symptoms of Upper GI Bleeding

• Bright red blood, dark clots, or coffee ground-like material in vomit
• Black, tar-like stool

Symptoms of Lower GI Bleeding

• Passing only bright red blood, or passing blood mixed in the stool (turning stool to black or tar-like)
• Bright red or maroon-colored blood in the stool

Symptoms of Acute Bleeding

• Weakness
• Shortness of breath
• Dizziness
• Rapid pulse
• Reduced urine flow
• Cramping abdominal pain
• Cold, clammy hands and feet
• Faintness
• Diarrhea
• Confusion
• Disorientation
• Sleepiness
• Bright red blood coating the stool
• Dark blood mixed with the stool
• Black or tarry stool
• Bright red blood in vomit
• "Coffee grounds" appearance of vomit

Symptoms of Chronic Bleeding

• Weakness
• Fatigue
• Shortness of breath
• Pallor
• Chest pain
• Dizziness
• Lethargy
• Faintness
• Bright red blood coating the stool
• Dark blood mixed with the stool
• Black or tarry stool
• Bright red blood in vomit
• Coffee grounds appearance of vomit

Causes

The digestive tract, also referred to as the gastrointestinal tract or GI tract, contains several parts. These include the esophagus, stomach, small intestine, large intestine (also called the colon), rectum, and anus.

Bleeding in the GI tract may have a number of different causes depending on where in the digestive system it occurs.

The Esophagus

• Inflammation (Esophagitis): Stomach acid that backs up into the esophagus can cause inflammation, and this inflammation may lead to bleeding.
• Varices: These are abnormally enlarged veins located at the lower end of the esophagus.
• Tears: A tear in the lining of the esophagus that is usually caused by prolonged vomiting, but may also be caused by prolonged coughing or hiccuping. This is sometimes called Mallory-Weiss syndrome, which is a disorder of the lower end of the esophagus caused by severe retching and vomiting and characterized by laceration associated with bleeding.
• Ulcers
• Cancer

In the Stomach

• Ulcers: Ulcers may enlarge and erode through a blood vessel, causing bleeding.
• Gastritis
• Cancer

In the Small Intestine

• Duodenal ulcer
• Inflammatory bowel disease: Inflammation may occur, which can lead to bleeding.
• Cancer

In the Large Intestine and Rectum

• Hemorrhoids: This is the most common cause of visible blood in the lower digestive tract, and is usually a bright red. They are enlarged veins in the anal area that can rupture and bleed.
• Ulcerative colitis: Inflammation and small ulcerations can cause bleeding.
• Crohn's disease: This is a chronic condition that can cause inflammation that may result in rectal bleeding.
• Colorectal cancer: This is a condition caused by out-pouching of the colon wall.

Diagnosis

A healthcare provider will usually begin the diagnostic process by recording the patient's medical history and doing a complete physical exam. During the exam, your healthcare provider will ask about your bowel habits (going more or less often than usual), stool color (black or red), and consistency (looser or more firm).

They will also ask if you are experiencing any pain or tenderness, and where it's located. The healthcare providerwill then follow with diagnostic tests if the exam didn't reveal a cause of the bleeding (such as hemorrhoids), or to determine if there is more than one cause for the bleeding. Diagnostic tests include:

• Upper endoscopy
• EGD (esophagogastroduodenoscopy)
• Colonoscopy
• Sigmoidoscopy
• Anoscopy
• Barium x-rays
• Biopsies

Treatment

Treatment of bleeding in the digestive tract depends on the cause of bleeding, and whether the bleeding is acute or chronic. For example, if aspirin is responsible for the bleeding, typically if a patient stops taking aspirin, the bleeding is treated.

If cancer is the cause of the bleeding, the usual course of treatment is the removal of the tumor. If a peptic ulcer is the cause of the bleeding, the healthcare provider may prescribe a drug for the treatment of H. pylori, recommend a change in diet, possibly a change in lifestyle.

The first step in the treatment of GI bleeding is to stop the bleeding. This is usually done by injecting chemicals directly into a bleeding site, or by cauterizing the bleeding site with a heater probe passed through an endoscope.

The next step is to treat the condition that caused the bleeding. This includes medications used to treat ulcers, esophagitis, H. pylori, and other infections. These include proton pump inhibitors (PPIs), H2 blockers, and antibiotics. Surgical intervention may also be needed, especially if the cause of the bleeding is a tumor or polyps, or if treatment with an endoscope is unsuccessful.