Definition

Gastrointestinal (GI) bleeding is bleeding in the digestive tract.

The Digestive Tract

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The digestive tract is divided into two sections: the upper and lower digestive tract.

The upper digestive tract includes the:

    
  • Esophagus (the muscular tube that transports food from the throat to the stomach)
  • Stomach
  • Upper portion of the small intestine

    • The lower digestive tract includes the:

        
  • Lower portion of the small intestine
  • Large intestine
  • Anus

    • GI bleeding is a potentially serious symptom that requires care from your doctor.

    Causes

    GI bleeding is a symptom caused by several possible conditions. Some of the causes of bleeding include:

    In the upper digestive tract:

        
  • Peptic ulcer —a sore in the lining of the stomach or the upper portion of the small intestine
  • Esophageal varices —abnormally swollen veins within the lining of the esophagus
  • Mallory-Weiss tears—tears in the lining of the esophagus
  • Gastritis —inflammation and ulcers in the lining of the stomach
  • Esophagitis—inflammation and ulcers in the lining of the esophagus
  • Benign tumors—abnormal tissue growth that is not cancerous
  • Cancer—cancer in the esophagus , stomach , or small intestine

    • In the lower digestive tract:

        
  • Angiodysplasia —abnormal growth of blood vessels in the intestine
  • Diverticulum—a pouch that forms on the wall of the large intestine (If the pouch becomes inflamed it is called diverticulitis .)
  • Colitis —inflammation of the colon (The colon is part of the large intestine.)
  • Hemorrhoids —enlarged veins in the anus or rectum
  • Fissures —tears in the anus
  • Polyps (abnormal growth) or cancer in the colon

    • Risk Factors

    Risk factors include:

        
  • Alcohol use
  • Long-term use of steroids, blood-thinning medicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin
  • Smoking
  • Prior GI or vascular surgery
  • History of gastrointestinal disease or bleeding
  • History of ulcers
  • History of bacterial infections ( Helicobacter pylori )
  • Age (This risk factor is also increased in older patients who take pain medicines.)

    • Symptoms

    If you have any of these symptoms, do not assume they are due to GI bleeding. Other things may cause these symptoms. Tell your doctor if you have:

    Upper digestive tract bleeding symptoms:

        
  • Blood in vomit
  • Vomit that looks like coffee grounds
  • Black, tarry stool
  • Blood in the stool

    • Lower digestive tract bleeding symptoms:

        
  • Black, tarry stool
  • Blood in the stool

    • It may be difficult to notice small amounts of blood in the stool. Your doctor can do tests to detect this.

    Sometimes, bleeding can occur suddenly and be severe. You may notice symptoms like:

        
  • Weakness
  • Dizziness or faintness
  • Shortness of breath
  • Abdominal pain
  • Diarrhea
  • Paleness

    • Bleeding that is light and occurs over a long period of time may make you feel tired and short of breath.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. He will do a physical exam. He will try to find the location and reason for bleeding.

    Tests may include:

        
  • Blood tests
  • Breath test
  • Stool test (to check for blood in the stool)
  • Endoscopy—a thin, lighted tube inserted down the throat to examine the digestive tract and collect tissue samples
  • Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
  • Computed tomography (CT) scan —a type of x-ray that uses a computer to make pictures of structures inside the digestive tract
  • Nasogastric lavage—a tube placed through the nose and into the stomach removes contents to check for bleeding
  • Barium x-ray —special x-rays made by having the patient drink a chemical called barium
  • Radionuclide scanning—the use of small amounts of radioactive material and a camera to create blood flow images of the digestive tract
  • Angiography —an x-ray of the blood vessels

    • Treatment

    If the doctor is able to figure out the condition causing your bleeding, he will provide you with care to treat it. He may prescribe medicines (eg, proton-pump inhibitors, acid suppressors). You and your doctor will talk about the best treatment plan for you.

    Treatment options to stop bleeding at the site include:

    Endoscopy

    Endoscopy can also be used to stop bleeding. With an endoscope (a tube that is placed into the mouth and intestine), the doctor can stop the bleeding by:

        
  • Injecting chemicals into the bleeding site
  • Using a heat probe, electric current, or laser to seal off the bleeding site
  • Using a band or clip to close off blood vessels

    • Angiography

    Angiography, which is also used as a diagnostic tool, can control bleeding. The doctor can use angiography (x-ray of blood vessels) with other tools to locate the bleeding and inject medicines or other materials into the blood vessels to control it.

    Sometimes if the doctor has tried other treatments and is unsuccessful, he may consider surgery.

    Prevention

    To help reduce your chance of GI bleeding, you will need to reduce the chance of having the conditions that cause it, like:

        
  • H. pylori bacteria infection
  • Gastroesophageal reflux disease (GERD)
  • Ulcer
  • Hemorrhoids
  • Polyps
  • Inflammatory bowel diseases

    • Discuss these and other possible conditions that may cause GI bleeding with your doctor to find out how to prevent them. You may also want to reduce your use of the following:

        
  • Alcohol
  • Tobacco
  • NSAIDs (if possible)