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Gastrointestinal Bleeding

Definition

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

The Digestive Tract
si55551180 97870 1 digestive tract
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The digestive tract is divided into two sections. 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 many possible conditions.

Causes in the upper digestive tract may include:

  • 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
  • Stomach arteriovenous malformations
  • Cancer—cancer in the esophagus , stomach , or small intestine

Causes in the lower digestive tract may include:

  • Angiodysplasia —abnormal growth of blood vessels in the intestine
  • Diverticulum—a pouch that forms on the wall of the large intestine
  • Diverticulitis —occurs when the pouch becomes inflamed
  • Colitis —inflammation of the colon (such as ulcerative colitis or Crohns disease)
  • Hemorrhoids —enlarged veins in the anus or rectum
  • Fissures —tears in the anus
  • Polyps or colon cancer

Risk Factors

Factors that may increase your chance of GI bleeding include:

  • Bleeding disorders (some more than other)
  • Excessive alcohol use
  • Long-term use of steroids, blood-thinning medication, 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, such as Helicobacter pylori

Symptoms

Upper digestive tract bleeding symptoms may include:

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

Lower digestive tract bleeding symptoms may include:

  • 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
  • Lightheadedness 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. A physical exam will be done.

Tests may include:

  • Blood tests
  • Breath test
  • Stool test to check for blood
  • 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
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the digestive tract
  • Nasogastric aspiration—a tube placed through the nose and into the stomach removes contents to check for bleeding
  • Barium x-ray —x-ray that uses contrast material to see internal structures
  • 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

Treatment will depend on the cause of the bleeding. Your doctor may switch your medications or stop certain ones if it is suspected as the cause of your GI bleeding. You may need to make some lifestyle changes.

Other treatments may include:

Medications

Your doctor may advise medications depending on your symptoms or the results of your tests. Examples include:

  • Proton pump inhibitors (PPIs) or H-2 blockers to reduce stomach acid production
  • Antibiotics to treat Helicobacter pylori or other infections
  • Vasoconstrictors to reduce bleeding
  • Corticosteroids to reduce inflammation
  • Probiotics to introduce healthy bacteria into the GI tract

Some treatments are more effective with a combination of medications.

Endoscopy

Endoscopy can also be used to stop bleeding. With an endoscope, your 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 with other tools to locate the bleeding and inject medications or other materials into the blood vessels to control it.

Surgery

If other treatment options fail, your doctor may recommend surgery. Surgery may be necessary for some conditions, such as diverticulitis or uncontrolled bleeding.

Prevention

To help reduce your chance of gastrointestinal bleeding, take these steps:

  • Get treatment for Helicobacter pylori infection
  • Reduce your intake of alcohol or NSAIDs if possible
  • If you smoke, talk with your doctor about how you can quit

Revision Information

  • The American College of Gastroenterology

    http://www.gi.org

  • American Gastroenterological Association

    http://www.gastro.org

  • Canadian Association of Gastroenterology

    http://www.cag-acg.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Acute lower gastrointestinal bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 21, 2013. Accessed June 20, 2014.

  • Acute upper gastrointestinal bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 21, 2013. Accessed June 20, 2014.

  • Barnert J, Messmann H. Management of lower gastrointestinal tract bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):295-312.

  • Bleeding in the digestive tract. National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/bleeding. Updated March 27, 2012. Accessed June 20, 2014.

  • Common cancer types. National Cancer Institute website. Available at: www.cancer.gov/cancertopics/commoncancers. Updated March 21, 2014. Accessed June 20, 2014.

  • Laine L, Jensen DM. Managment of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360.

  • Laine L, Smith R, Min K, Chen C, Dubois RW. Systematic review: the lower gastrointestinal adverse effects of nonsteroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2006;24(5):751-767.

  • Loke YK, Derry S. Risk of gastrointestinal haemorrhage with long-term use of aspirin: meta-analysis. BMJ. 2000;321:1183.

  • Wilcox CM, Alexander LN, Cotsonis GA, Clark WS. Nonsteroidal anti-inflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci. 1997;42(5):990-997.