Gastrointestinal Bleeding - Overview

The many causes of gastrointestinal (GI)  bleeding are classified into upper or lower, depending on their location in the GI tract. 

• Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-the esophagus, stomach,  or duodenum (first part of the intestine). Bleeding can come from ingestion of caustic poisons or stomach cancer. Most often, upper GI bleeding is caused by one of the following: 

• Lower  gastrointestinal bleeding: Lower GI bleeding originates in the portions of the GI  tract farther down  the digestive system-the segment of the  small intestine farther from the stomach, large intestine, rectum,  and anus. Diverticular disease, angiodysplasia, polyps, hemorrhoids, and anal fissures most commonly cause the bleeding. Blood in the stool  can result from cancers, inflammatory bowel disease, and infectious diarrhea. 

Gastrointestinal Bleeding Causes 

The many causes of gastrointestinal bleeding are classified into upper  or lower, depending on their location in the GI tract. 

Upper GI bleeding 

• Peptic ulcer disease: Peptic ulcers are localized erosions  of the wall  of the digestive tract. Ulcers usually occur in the stomach or duodenum. Breakdown of the walls results in damage to blood vessels, causing bleeding. When the mucous membranes break down, they are unable to counteract the harsh effects of stomach acid. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, and cigarette smoking promote gastric ulcer formation. Helicobacter pylori are a type of bacteria that also promote formation of ulcers. 
• Gastritis: General inflammation of the stomach wall, which can result in bleeding. Gastritis also results from an inability of the gastric lining to protect itself from the acid it produces. NSAIDs, steroids, alcohol, burns, and trauma can cause gastritis. 
• Esophageal varices: Swellings in veins of your esophagus or stomach usually result from liver disease. Varices most commonly result from alcoholic liver cirrhosis. When varices bleed, the  bleeding can be massive and catastrophic and occur without warning. 
• Mallory-Weiss tear: A tear in the esophageal or stomach wall, often as  a result of vomiting or retching. Tears also  can occur after seizures, forceful coughing or laughing, lifting, straining, or childbirth. Physicians often  find tears in people who have recently binged on alcohol. 

Lower  GI bleeding

• Diverticulosis: One  of the most common causes of lower GI bleeding. Small out-pockets, or diverticula, form on part of the wall of your colon (large intestine), usually in  a weakened area of the bowel wall. You may develop several pockets, which  are more common in people who have constipation and strain at stool. 
• Angiodysplasia: Along with diverticulosis, this is one of the most common  causes of lower GI bleeding. Angiodysplasia is a malformation in the blood vessels in the wall of the GI tract. The sores are most common in the large intestine and often bleed. The elderly and people with chronic kidney failure develop the disease most often. 
• Polyps: Intestinal polyps are noncancerous tumors of the GI tract, occurring mostly in people older than 40 years. A small proportion of these polyps may transform into cancer. Colonic polyps may bleed rapidly, or they may bleed slowly and go undetected. 
• Hemorrhoids and fissures: Hemorrhoids are swellings of veins in and around your rectum. Repeated stretching from straining at stool causes them to bleed. Bleeding from hemorrhoids is usually mild, intermittent, and bright red. Massive bleeding is rare. Anal fissures, or tears in the anal wall, also may trigger small amounts of bright red bleeding from the anus. Forceful straining during passage of hard stool usually causes such tears, which can be very painful. 

Gastrointestinal Bleeding Symptoms 

Acute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements,  or black, tarry stools. Blood may look like "coffee grounds." Symptoms associated with blood loss can include  the following:

• Fatigue
• Weakness  
• Shortness of breath 
• Abdominal pain 
• Pale appearance 
• Vomiting of blood usually originates from an upper GI source. Bright red or maroon stool can be from either a lower GI source or from brisk bleeding at an upper GI source. 
• Long-term GI bleeding may go unnoticed or may cause fatigue, anemia, black stools, or a positive test for microscopic blood. 

When to Seek Medical Care 

Any presence of blood  in the stool  or the upper gastrointestinal tract is significant and needs medical investigation. Black or dark stools may represent slow bleeding into the GI tract and should be investigated by a physician. 

Any significant bleeding into the GI tract, either vomited blood or blood through the rectum, should be evaluated in the emergency department. 

Exams and Tests 

• A doctor will perform a complete history and physical exam to evaluate your problem.  The physical will include a digital rectal exam,  to test for visible or microscopic blood from your rectum. 
• The doctor may need to insert a tube through your nose into your stomach to help identify  the source of the bleeding. The procedure  is called endoscopy. An endoscope is  a long tube with a tiny camera on the end. It may be passed  through the nose into the stomach,  or through the  rectum into the colon,  to directly see  the source of bleeding. Endoscopy can be both diagnostic, finding  the source of bleeding, and therapeutic, stopping it. 
• Lab tests also can be helpful to determine the rate or severity of bleeding and to determine factors that may contribute to the problem. 

Gastrointestinal Bleeding Treatment 

Self-Care at Home 

There is no home care for heavy gastrointestinal bleeding. Go to a hospital's emergency department. For hemorrhoids or anal fissures, eat a diet high in fiber and fluids to keep stools soft. 

Medical Treatment 

• Serious gastrointestinal bleeding can destabilize your vital signs. For instance, your blood pressure may fall sharply and your heart rate will increase. 
• The physician may need to resuscitate you with IV fluids and possibly a blood transfusion. 

In some cases, you may need surgery.