Gastrointestinal Bleeding: Causes, Types, Symptoms & Management

Gastrointestinal (GI) bleeding is bleeding anywhere in the digestive tract. It is a sign of another problem, not a disease on its own, and is also called gastrointestinal hemorrhage. Your digestive tract consists of the following organs:

• esophagus
• stomach
• The small intestine, including the duodenum
• large intestine or colon
• rectum
• anus

These parts divide the whole digestive tract into two major parts upper GIT and lower GIT. The esophagus, stomach, or initial part of the small intestine (duodenum), it’s considered upper GIT and the lower small intestine, large intestine, rectum, or anus are considered lower GIT.

Symptoms of this GI bleeding depends on the location of the bleeding in GIT(from mouth to anus) and the rate of bleeding. It can be mild, moderate, and severe or it can be life-threatening. Blood can come out in the form of vomit or can pass through stool (overt bleeding) or it can be occult(hidden).

The amount can range from a trace of blood to a life-threatening hemorrhage. If you vomit blood, pass black or bloody stools, or feel faint, seek emergency care right away.

Symptoms of Gastrointestinal Bleeding

GI bleeding from any site or in any form produces some clinical signs and symptoms that may warn you about your health. Symptoms depend on the type of bleeding.

Overt (acute) bleeding symptoms

These may include bright red blood in vomit, vomit that looks like coffee grounds, black tarry stools, or dark or bright red blood mixed with stool. You may also feel dizzy, faint, tired or short of breath, or have abdominal cramps.

Occult (hidden) bleeding symptoms

Occult bleeding is too small to see, so it is found with stool or blood tests. Over time it can cause anemia, with tiredness, pale skin and shortness of breath.

If bleeding is rapid and heavy, a person can go into shock. Signs include a fast heart rate, low blood pressure, pale or cold skin, sweating, confusion and fainting. Shock is a medical emergency.

Classification of Gastrointestinal Bleeding

GI bleeding is broadly categorized into two major types based upon their site of bleeding That maybe

• Acute/ Chronic Upper GI bleeding
• Acute/ Chronic lower GI bleeding

1- Acute Upper Gi Bleeding

Acute upper GI bleeding may originate in the upper part of the digestive tracts such as the esophagus, stomach, and duodenum. Upper GI bleeding can be classified based upon anatomic and pathophysiologic factors: ulcerative, vascular, traumatic, iatrogenic, tumors, portal hypertension. Common causes of upper GI bleeding include peptic ulcers (most often from H. pylori infection or NSAIDs such as aspirin and ibuprofen), gastritis, esophagitis, varices, Mallory-Weiss tears from severe vomiting, and tumors, including stomach cancer. Blood thinners raise the risk.

How Patients Of Upper Gi Bleeding Presents?

Patients having Upper GI bleeding usually presents with the

• Hematemesis (vomiting of the fresh blood), * “coffee-ground” emesis (vomiting of dark brown blood),
• The presence of frank bloody emesis suggests more active and severe bleeding in comparison to the coffee-ground emesis
• And/or melena (black tarry stools). Hematochezia (passing of red blood from the rectum). It shows the bleeding from the lower gastrointestinal tract but sometimes it can be an indication for a briskly bleeding upper GI source.

Variceal hemorrhage, bleeding from enlarged veins in the esophagus or stomach, is life-threatening. Varices are most often linked to cirrhosis, so doctors consider them early in anyone with liver disease.

2- Acute Lower Gi Bleeding

Acute lower GI bleeding may originate in the lower part of digestive tracts such as small bowel, colon, or rectum. The causes of acute lower GI bleeding may also be grouped into categories based on the pathophysiology: vascular, inflammatory, neoplastic, traumatic, and iatrogenic. Common causes of lower GI bleeding are angiodysplasia (abnormal blood vessels), diverticular disease, neoplasms including colorectal cancer, Crohn’s disease, and ulcerative colitis, and benign anorectal lesions such as anal fissures, hemorrhoids, and rectal ulcers.

How Patients With Lower Gi Bleeding Present?

Patients having Lower GI bleeding usually present with the hematochezia, bleeding from the right colon or the small intestine can present with melena.

Bleeding from the left side of the colon tends to present bright red in color, whereas bleeding from the right side of the colon often appears dark or maroon-colored and may be mixed with stool.

Complications of Gastrointestinal Bleeding

Untreated or heavy bleeding can lead to anemia, shock and, in severe cases, death from blood loss.

Treatment of Gastrointestinal Bleeding

Treatment depends on how severe the bleeding is, its cause and where it is. Doctors use a history, exam and tests such as a complete blood count, liver and kidney tests, stool tests and imaging.

Endoscopy is the main tool. During an upper endoscopy or colonoscopy, a doctor can often find and treat the bleeding site at the same time, using injections, heat, clips or bands. Angiography or surgery may be needed if bleeding doesn't stop.

Peptic ulcers, a common cause of upper GI bleeding, are treated with acid-reducing medicines such as proton pump inhibitors, antibiotics if H. pylori is present, and stopping NSAIDs when possible.

If a patient presents with gastrointestinal bleeding and cirrhosis, they need to undergo urgent endoscopy and the source of the bleed needs to be identified as soon as possible. If the cause is esophageal varices, endoscopic band ligation is the usual first-line treatment. For bleeding that doesn't stop, a transjugular intrahepatic portosystemic shunt (TIPS) may be an option.

Treatment for esophagitis depends on its cause. Possible treatments include antibiotics, antivirals, antifungals, steroids, and endoscopy to remove any lodged pill fragments.

HP Thoughts: Sometimes we become afraid of what is happening to our body that we lose rationality and start forming our own diagnosis. One example of an ailment that we are quick to jump to conclusions about is nausea. Learn more about this: Nausea After Eating.

Conclusion

The first step is to find the cause, site, rate and amount of bleeding. Once your doctor knows the cause, they can tailor treatment. Never ignore blood in vomit or stool; get medical care promptly.

Related Post: Epigastric Pain

Sources

• Symptoms & Causes of GI Bleeding, NIDDK
• Treatment for GI Bleeding, NIDDK