Gastrointestinal Bleeding

Alternative names: GI bleed, GI bleeding, Gastrointestinal Hemorrhage

Bleeding may occur anywhere along the digestive tract, from the mouth to the anus, for a variety of reasons.  Blood may be visible in the stool or in vomit or may be hidden (occult) and detectable only by diagnostic tests.

Signs and Symptoms

Aside from those mentioned below, symptoms of gastrointestinal bleeding also include vomiting blood (hematemesis).  Vomited blood may be red, or black like coffee grounds.

The following symptoms may indicate rapid blood loss, which is very serious:

• a rapid pulse rate
• low blood pressure
• reduced urine flow
• cold, clammy hands and feet
• confusion, disorientation, sleepiness, and even shock caused by a reduced supply of blood to the brain.

Diagnosis and Tests

Once it has been established that bleeding has occurred or is occurring, the first step is to rule out hemorrhoids, rectal tears (fissures), and tumors by performing a rectal examination.  The next step may include tests such as different types of X-rays and/or endoscopy, depending on whether the doctor suspects that the bleeding is coming from the upper digestive tract (esophagus, stomach, and first segment of the small intestine) or lower digestive tract (lower small intestine, large intestine, rectum, and anus).

Laboratory findings:

• Gross or occult blood in stool, vomitus, or gastric contents
• Hypochromic, microcytic anaemia, iron-deficiency type, due to chronic blood loss
• Altered liver function tests suggest cirrhosis of the liver with oesophageal varices as the source of bleeding
• Increased BUN due to breakdown of blood in the colon by bacteria resulting in increased nitrogen formation
• Laboratory findings or any of the underlying conditions listed above.

Treatment and Prevention

If a large amount of blood has been lost, fluids are given intravenously, and a blood transfusion may be needed.  After a blood transfusion, the person is observed closely for evidence of continued bleeding, such as an increased pulse rate, a drop in blood pressure, or a loss of blood from the mouth or anus.

Bleeding from esophageal varices can be treated in several ways.  In one method, an irritating chemical is injected into the bleeding vessels through an endoscope, causing inflammation and scarring of the veins, which stops the bleeding (sclerotherapy).  In a second, more frequently used method, the varices are tied off with rubber bands during endoscopy (rubber band ligation).  In a third method, now rarely used, a catheter with a deflated balloon at its tip is inserted through the mouth into the esophagus, and the balloon is then inflated to apply pressure on the bleeding area (esophageal tamponade).

Bleeding in the stomach often can be stopped with one of several procedures performed with an endoscope; these involve using an electrical current to destroy the portion of a vessel that is bleeding (cauterization) or injecting a material that causes clotting within the bleeding vessel.  If these procedures fail, surgery may be needed.

Bleeding of the lower intestine usually does not require emergency treatment unless the person loses a large amount of blood quickly.  Tests to locate the bleeding precisely, such as endoscopy or radionuclide scans, may be needed.  Surgery can be performed if bleeding does not stop.

Prognosis

Gastrointestinal bleeding is self-limiting in more than 80% of cases: the body is able to stop the bleeding on its own.  Patients who continue to bleed or who have symptoms of a sudden loss of a large amount of blood usually are hospitalized and often are admitted to an intensive care unit.