Gastrointestinal bleeding

 

Gastrointestinal bleeding

Overview

Gastrointestinal (GI) bleeding is a symptom of a disorder in your digestive tract. The blood often appears in stool or vomit but isn't always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and can be life-threatening.

Sophisticated imaging technology, when needed, can usually locate the cause of the bleeding. Treatment depends on the source of the bleeding.

Symptoms

Signs and symptoms of GI bleeding can be either obvious (overt) or hidden (occult). Signs and symptoms depend on the location of the bleed, which can be anywhere on the GI tract, from where it starts — the mouth — to where it ends — the anus — and the rate of bleeding.

Overt bleeding might show up as:

·         Vomiting blood, which might be red or might be dark brown and resemble coffee grounds in texture

·         Black, tarry stool

·         Rectal bleeding, usually in or with stool

With occult bleeding, you might have:

·         Lightheadedness

·         Difficulty breathing

·         Fainting

·         Chest pain

·         Abdominal pain

Symptoms of shock

If your bleeding starts abruptly and progresses rapidly, you could go into shock. Signs and symptoms of shock include:

·         Drop in blood pressure

·         Not urinating or urinating infrequently, in small amounts

·         Rapid pulse

·         Unconsciousness

When to see a doctor

If you have symptoms of shock, you or someone else should call 911 or your local emergency medical number. If you're vomiting blood, see blood in your stools or have black, tarry stools, seek immediate medical care. For other indications of GI bleeding, make an appointment with your doctor.

Causes

Gastrointestinal bleeding can occur either in the upper or lower gastrointestinal tract. It can have a number of causes.

Upper GI bleeding

Causes can include:

·         Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining of the stomach and upper portion of the small intestine. Stomach acid, either from bacteria or use of anti-inflammatory drugs, damages the lining, leading to formation of sores.

·         Tears in the lining of the tube that connects your throat to your stomach (esophagus). Known as Mallory-Weiss tears, they can cause a lot of bleeding. These are most common in people who drink alcohol to excess.

·         Abnormal, enlarged veins in the esophagus (esophageal varices). This condition occurs most often in people with serious liver disease.

·         Esophagitis. This inflammation of the esophagus is most commonly caused by gastroesophageal reflux disease (GERD).

Lower GI bleeding

Causes can include:

·         Diverticular disease. This involves the development of small, bulging pouches in the digestive tract (diverticulosis). If one or more of the pouches become inflamed or infected, it's called diverticulitis.

·         Inflammatory bowel disease (IBD). This includes ulcerative colitis, which causes inflammation and sores in the colon and rectum, and Crohn's disease, and inflammation of the lining of the digestive tract.

·         Tumors. Noncanerous (benign) or cancerous tumors of the esophagus, stomach, colon or rectum can weaken the lining of the digestive tract and cause bleeding.

·         Colon polyps. Small clumps of cells that form on the lining of your colon can cause bleeding. Most are harmless, but some might be cancerous or can become cancerous if not removed.

·         Hemorrhoids. These are swollen veins in your anus or lower rectum, similar to varicose veins.

·         Anal fissures. These are small tears in the lining of the anus.

·         Proctitis. Inflammation of the lining of the rectum can cause rectal bleeding.

Complications

A gastrointestinal bleed can cause:

·         Shock

·         Anemia

·         Death

Prevention

To help prevent a GI bleed:

·         Limit your use of nonsteroidal anti-inflammatory drugs.

·         Limit your use of alcohol.

·         If you smoke, quit.

·         If you have GERD, follow your doctor's instructions for treating it.

Diagnosis

Your doctor will take a medical history, including a history of previous bleeding, conduct a physical exam and possibly order tests. Tests might include:

·         Blood tests. You may need a complete blood count, a test to see how fast your blood clots, a platelet count and liver function tests.

·         Stool tests. Analyzing your stool can help determine the cause of occult bleeding.

·         Nasogastric lavage. A tube is passed through your nose into your stomach to remove your stomach contents. This might help determine the source of your bleed.

·         Upper endoscopy. This procedure uses a tiny camera on the end of a long tube, which is passed through your mouth to enable your doctor to examine your upper gastrointestinal tract.

·         Colonoscopy. This procedure uses a tiny camera on the end of a long tube, which is passed through your rectum to enable your doctor to examine your large intestine and rectum.

·         Capsule endoscopy. In this procedure, you swallow a vitamin-size capsule with a tiny camera inside. The capsule travels through your digestive tract taking thousands of pictures that are sent to a recorder you wear on a belt around your waist. This enables your doctor to see inside your small intestine.

·         Flexible sigmoidoscopy. A tube with a light and camera is placed in your rectum to look at your rectum and the last part of the large intestine that leads to your rectum (sigmoid colon).

·         Balloon-assisted enteroscopy. A specialized scope inspects parts of your small intestine that other tests using an endoscope can't reach. Sometimes, the source of bleeding can be controlled or treated during this test.

·         Angiography. A contrast dye is injected into an artery, and a series of X-rays are taken to look for and treat bleeding vessels or other abnormalities.

·         Imaging tests. A variety of other imaging tests, such as an abdominal CT scan, might be used to find the source of the bleed.

If your GI bleeding is severe, and noninvasive tests can't find the source, you might need surgery so that doctors can view the entire small intestine. Fortunately, this is rare.

Treatment

Often, GI bleeding stops on its own. If it doesn't, treatment depends on where the bleed is from. In many cases, medication or a procedure to control the bleeding can be given during some tests. For example, it's sometimes possible to treat a bleeding peptic ulcer during an upper endoscopy or to remove polyps during a colonoscopy.

If you have an upper GI bleed, you might be given an IV drug known as a proton pump inhibitor (PPI) to suppress stomach acid production. Once the source of the bleeding is identified, your doctor will determine whether you need to continue taking a PPI.

Depending on the amount of blood loss and whether you continue to bleed, you might require fluids through a needle (IV) and, possibly, blood transfusions. If you take blood-thinning medications, including aspirin or nonsteroidal anti-inflammatory medications, you might need to stop.

Preparing for your appointment

If your bleeding is not severe, you might start by seeing your primary care provider. Or you might be referred immediately to a specialist in gastrointestinal disorders (gastroenterologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before a specific test. Make a list of:

·         Your symptoms, including any that seem unrelated to the reason for your appointment and when they began

·         All medications, vitamins or other supplements you take, including doses

·         History of digestive disease you've been diagnosed with, such as GERD, peptic ulcers or IBD

·         Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For gastrointestinal bleeding, basic questions to ask your doctor include:

·         I'm not seeing blood, so why do you suspect a GI bleed?

·         What's likely causing my symptoms?

·         Other than the most likely cause, what are other possible causes for my symptoms?

·         What tests do I need?

·         Is my condition likely temporary or chronic?

·         What's the best course of action?

·         What are the alternatives to the primary approach you're suggesting?

·         I have other health conditions. How can I best manage them while my bleeding is treated?

·         Are there restrictions I need to follow?

·         Should I see a specialist?

·         Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

·         Have your symptoms been continuous or occasional?

·         How severe are your symptoms?

·         What, if anything, seems to improve your symptoms?

·         What, if anything, appears to worsen your symptoms?

·         Do you take non-steroidal anti-inflammatory medication, either over-the –counter or prescribed, or do you take aspirin?

·         Do you drink alcohol?