Definition

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

The digestive tract is divided into 2 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
• Rectum and 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 rectum and/or anus
• 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:

Prevention

To help reduce your chance of gastrointestinal bleeding:

• 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

American Gastroenterological Association http://www.gastro.org

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

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