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Gastrointestinal Bleeding

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Gastrointestinal (GI) bleeding is a symptom of a disorder affecting the digestive system and its organs. The bleeding can range from mild to severe bleeding that can lead to death.


Bleeding that occurs anywhere in the gastrointestinal tract is called as GI bleeding. The organs included in the digestive tract are:

  • Esophagus
  • Stomach
  • Small intestine
  • Large intestine
  • Rectum
  • Anus

The bleeding can occur in any area of these organs. Upper GI bleeding is considered when it occurs in esophagus, stomach as well as the small intestine. When it happens in the large intestine, rectum or the anus, it is called lower GI bleeding.

Symptoms of Gastrointestinal Bleeding

Gastrointestinal bleeding is usually detected when one vomits blood or passes blood with stools. At times the bleeding is so mild, that it can only be detected with the help of lab tests. Digested blood passed through stools is black in color. Thus, leading to tarry stools called melena.

Melena are black colored tarry stools that are usually seen in case of upper GI bleeding. However, in some cases lower GI may also lead to melena. Hematemesis also occurs with upper GI bleeding. It is vomiting of red blood from the varix or any arterial source. When one vomits ‘coffee-ground’ emesis, that is, granular, dark brown vomit, it indicates upper GI bleeding that has ceased. The gastric acid digests the hemoglobin to brown hematin.

Causes of Gastrointestinal Bleeding

There are different conditions that can lead to GI bleeding in different organs. These causes include:

Upper gastrointestinal bleeding can be caused by peptic ulcer disease in most cases. Other causes included esophagitis as well as erosive disease. Duodenal ulcers, Mallory-Weiss tears, angiodysplasia and cancers.

Lower gastrointestinal bleeding causes include ulcerative colitis, Crohn’s disease, hemorrhoids, cancer, angiodysplasia, aortoenteric fistula.

Severe bleeding may occur in patients who suffer from alcohol abuse or chronic hepatitis. Patients who use anticoagulants like heparin or warfarin, also show signs of severe bleeding. Use of other drugs such as NSAIDs as well as aspirin can also lead to heavy GI bleeding.

Diagnosis for Gastrointestinal Bleeding

The patient is physically evaluated and his/her medical history taken. If necessary, the patient is stabilized with the help of airway management, IV fluids, transfusions, etc. along with the diagnostic evaluation.

The patient is asked if they had vomited blood immediately or observed presence of blood after vomiting a non-bloody vomit. In case of rectal bleeding, the patient should be asked when and where did they observe the blood. This means, whether they saw pure blood beinn passed through the rectum, or the blood was mixed with stool, pus or mucus, or the stool was just covered in blood.

Any other symptoms such as weight loss, anemia, unexplained bruising, etc. should also be noted.

Diagnosis is carried out by observation of blood in vomit or stool of patients. Tests such as fecal occult blood test, gastric aspiration, cross matching blood, CT angiography, etc. can be carried out to confirm GI bleeding. Other tests carried out include:

Treatment for Gastrointestinal Bleeding

The treatment begins with airway management and fluid resuscitation with the help of intravenous fluids or blood. Proton pump inhibitors will help reduce mortality in people with peptic ulcers. In case of variceal bleeding, use of octerotide or vasopression and nitroglycerin is used to reduce the portal pressure. Endoscopy helps in diagnosis as well as treatment of gastrointestinal bleeding.

GI bleeding causes death in patients who are affected by other diseases such as cancer or cirrhosis. Only 7% deaths are due to GI bleeding. In about 80% cases, the bleeding stops on its own. Speak to your healthcare provider for more details related to the conditions.

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Written by: Saptakee sengupta
Date last updated: April 07, 2015

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