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:

• Angiodysplasia—a growth of blood vessels in the intestine
• Diverticulum—a pouch that forms on the wall of the large intestine
• Diverticulitis—happens when the pouch becomes inflamed
• Inflammatory bowel diseases
• Hemorrhoids—enlarged veins in the rectum or anus
• Fissures—tears in the anus
• Polyps, or cancer in the colon, rectum, or anus

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:

Prevention

To lower the risk of GI bleeding:

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