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(GI Bleeding)

Definition

Gastrointestinal (GI) bleeding is bleeding in the digestive tract. It can be deadly.

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The upper digestive tract is the:

  • Esophagus—the tube that moves food from the mouth to the stomach
  • Stomach
  • Upper part of the small intestine

The lower digestive tract is the:

  • Lower part of the small intestine
  • Large intestine
  • Rectum and anus

Causes

GI bleeding has many causes.

Causes in the upper digestive tract:

  • Peptic ulcer—a sore in the lining of the stomach or part of the small intestine
  • Esophageal varices—swollen veins in the esophageal lining
  • Mallory-Weiss tears—tears in the esophageal lining
  • Gastritis—inflammation and sores in the stomach lining
  • Esophagitis—inflammation and sores in the esophageal lining
  • Benign tumors—noncancerous growths
  • Stomach arteriovenous malformations
  • Cancer in the esophagus, stomach, or small intestine

Causes in the lower digestive tract:

Risk Factors

Things that may raise the risk of this problem are:

  • Having bleeding problems
  • Alcohol use disorder
  • Long-term use of steroids, blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin
  • Smoking
  • Prior GI or vascular surgery
  • Prior GI disease or bleeding
  • Prior ulcers
  • Prior infections, such as Helicobacter pylori

Symptoms

Upper and lower digestive tract bleeding may cause:

  • Black, tarry stool
  • Blood in the stool

Upper digestive tract bleeding may also cause:

  • Blood in vomit
  • Vomit that looks like coffee grounds

Sometimes, bleeding can happen quickly and be severe. This may cause:

  • Weakness
  • Light-headedness or faintness
  • Breathing problems
  • Belly pain
  • Diarrhea
  • Pale skin

Bleeding may be light and happen for a long time. This may cause a person to be tired and have problems breathing.

Diagnosis

The doctor will ask about your symptoms and health history.

Tests that may be done are:

  • Blood tests
  • Breath test
  • Stool test to check for blood
  • Upper GI endoscopy—a thin, lighted tube is placed in the mouth and moved into the stomach and upper part of the small intestine
  • Colonoscopy—a thin, lighted tube is placed in the anus and moved into the rectum and large intestine
  • CT scan
  • A nasogastric tube placed through the nose and into the stomach
  • Barium x-ray—contrast material is swallowed or used as an enema to see structures
  • Radionuclide scanning—to see how blood flows through the GI tract
  • Angiography—to see the blood vessels

Treatment

Treatment depends on what is causing the bleeding. Some choices are:

Medicines

Medicines may need to be stopped or changed. Depending on the cause, one or more other medicines may be used to:

  • Lower the amount of acid the stomach makes
  • Treat bacterial infections
  • Lessen bleeding
  • Lessen inflammation
  • Place healthy bacteria into the GI tract

Endoscopy

Endoscopy can also be used to stop bleeding by:

  • Injecting chemicals into the bleeding site
  • Using a heat probe, electric current, or laser to seal off the bleeding site
  • Using a band or clip to close off blood vessels

Angiography

Angiography can also be used to control bleeding. Other tools are used to find the bleeding. Medicines or other materials are injected into the blood vessels to control it.

Surgery

Surgery may be used when other methods fail. It may be needed to treat problems, such as uncontrolled bleeding.

Prevention

To lower the risk of GI bleeding:

  • Limit alcohol use.
  • Use NSAIDs as advised.
  • Do not smoke.

RESOURCES

American College of Gastroenterology  http://patients.gi.org 

National Institute of Diabetes and Digestive and Kidney Diseases  https://www.niddk.nih.gov 

CANADIAN RESOURCES

Canadian Association of Gastroenterology  https://www.cag-acg.org 

Canadian Digestive Health Foundation  http://www.cdhf.ca 

References

Acute lower gastrointestinal bleeding in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-lower-gastrointestinal-bleeding-in-adults. Accessed October 23, 2020.

Acute nonvariceal upper gastrointestinal bleeding. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/acute-nonvariceal-upper-gastrointestinal-bleeding. Accessed October 23, 2020.

Barkun AN, Almadi M, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019 Oct 22 early online, and previous version can be found in Ann Intern Med 2010 Jan 19;152(2):101.

Gastrointestinal (GI) bleeding. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding. Accessed October 23, 2020.

Overview of gastrointestinal bleeding. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastrointestinal-bleeding/overview-of-gastrointestinal-bleeding. Accessed October 23, 2020.

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