Carl R. Darnall Army Medical Center - Health Library

Gastrointestinal Bleeding

(GI Bleeding)

Pronounced: gas-tro-in-TEHS-teh-nahl blee-ding

Definition

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

si55551180_97870_1_digestive_tract

Copyright © Nucleus Medical Media, Inc.

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

GI bleeding can be a life-threatening problem that needs care right away.

Causes ^

GI bleeding has many causes.

Causes in the upper digestive tract:

  • Peptic ulcer—a sore in the lining of the stomach or the 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 ^

Your chances of GI bleeding are higher for:

  • 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 digestive tract bleeding may cause:

  • Blood in vomit
  • Vomit that looks like coffee grounds
  • Black, tarry stool
  • Blood in the stool

Lower digestive tract bleeding may cause:

  • Black, tarry stool
  • Blood in the stool

You many not see small amounts of blood in the stool. Your doctor can find it with testing.

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

  • Feeling weak
  • Lightheadedness or faintness
  • Breathing problems
  • Belly pain
  • Diarrhea
  • Pale skin

Bleeding that is light and happens over a long period of time may make you feel tired and cause breathing problems.

Diagnosis ^

Your doctor will ask about your symptoms and health history.

You may have:

  • A physical exam
  • 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's causing the bleeding. If medicines are causing problems, your doctor may stop or change them. You may need to make lifestyle changes.

Medicines

The type you need depends on what is causing problems. They're used to:

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

For some people, more than one type may be needed.

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 some conditions such as diverticulitis or uncontrolled bleeding.

Prevention ^

To help lower your chances of GI bleeding:

  • If you have a GI problem, treat it as advised by your doctor.
  • Don't drink alcohol. If you do, drink in moderation. Moderation is 2 drinks a day or less for men and 1 drink a day or less for women.
  • Use NSAIDs as advised or try to avoid them completely.
  • Quit smoking. Your doctor will help you find the best way to do this.
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. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114280/Acute-lower-gastrointestinal-bleeding. Updated December 6, 2017. Accessed August 15, 2018.

Acute upper nonvariceal gastrointestinal bleeding. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T905671/Acute-upper-nonvariceal-gastrointestinal-bleeding. Updated May 29, 2018. Accessed August 15, 2018.

Barnert J, Messmann H. Management of lower gastrointestinal tract bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):295-312.

Common cancer types. National Cancer Institute website. Available at: hhttps://www.cancer.gov/types/common-cancers. Updated February 26, 2018. Accessed August 15, 2018.

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 August 15, 2018.

Laine L, Jensen DM. Managment of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360.

Laine L, Smith R, Min K, Chen C, Dubois RW. Systematic review: the lower gastrointestinal adverse effects of nonsteroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2006;24(5):751-767.

Loke YK, Derry S. Risk of gastrointestinal haemorrhage with long-term use of aspirin: Meta-analysis. BMJ. 2000(7270);321:1183-1187.

Overview of GI bleeding. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gastrointestinal-disorders/gi-bleeding/overview-of-gi-bleeding. Updated January 2018. Accessed August 15, 2018.

Wilcox CM, Alexander LN, Cotsonis GA, Clark WS. Nonsteroidal anti-inflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci. 1997;42(5):990-997.

Last reviewed June 2018 by EBSCO Medical Review Board Daus Mahnke, MD  Last Updated: 8/15/2018