Gastrointestinal bleeding

  • Definition
    • Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract.

      Bleeding may come from any site along the GI tract, but is often divided into:

      • Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine.
      • Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus.
  • Alternative Names
    • Lower GI bleeding; GI bleeding; Upper GI bleeding

  • Considerations
    • The amount of GI bleeding may be so small that it can only be detected on a lab test such as the fecal occult blood test. Other signs of GI bleeding include:

      • Dark, tarry stools
      • Larger amounts of blood passed from the rectum
      • Small amounts of blood in the toilet bowl, on toilet paper, or in streaks on stool (feces)
      • Vomiting blood

      Massive bleeding from the GI tract can be dangerous. However, even very small amounts of bleeding that occur over a long period of time can lead to problems such as anemia or low blood counts.

      Once a bleeding site is found, many therapies are available to stop the bleeding or treat the cause.

  • Causes
    • GI bleeding may be due to conditions that are not serious, including:

      • Anal fissure
      • Hemorrhoids

      GI bleeding may also be a sign of more serious diseases and conditions. These may include cancers of the GI tract such as:

      • Cancer of the colon
      • Cancer of the small intestine
      • Cancer of the stomach
      • Intestinal polyps (a pre-cancerous condition)

      Other causes of GI bleeding may include:

      • Abnormal blood vessels in the lining of the intestines (also called angiodysplasia)
      • Bleeding diverticulum, or diverticulosis
      • Crohn's disease or ulcerative colitis
      • Esophageal varices
      • Esophagitis
      • Gastric (stomach) ulcer
      • Intussusception (bowel telescoped on itself)
      • Mallory-Weiss tear
      • Meckel's diverticulum
      • Radiation injury to the bowel
  • Home Care
    • There are home stool tests for microscopic blood that may be recommended for people with anemia or for colon cancer screening.

  • When to Contact a Medical Professional
    • Call your health care provider if:

      • You have black, tarry stools (this may be a sign of GI bleeding)
      • You have blood in your stool
      • You vomit blood or you vomit material that looks like coffee grounds
  • What to Expect at Your Office Visit
    • Your provider may discover GI bleeding during an exam at your office visit.

      GI bleeding can be an emergency condition that requires immediate medical care. Treatment may involve:

      • Blood transfusions
      • Fluids and medicines through a vein
      • Esophagogastroduodenoscopy (EGD). A thin tube with a camera on the end is passed through your mouth into your esophagus, stomach, and small intestine
      • A tube is placed through your mouth into the stomach to drain the stomach contents (gastric lavage)

      Once your condition is stable, you will have a physical exam and a detailed exam of your abdomen. You will also be asked questions about your symptoms, including:

      • When did you first notice symptoms?
      • Did you have black, tarry stools or red blood in the stools?
      • Have you vomited blood?
      • Did you vomit material that looks like coffee grounds?
      • Do you have a history of peptic or duodenal ulcers?
      • Have you ever had symptoms like this before?
      • What other symptoms do you have?

      Tests that may be done include:

      • Abdominal CT scan
      • Abdominal MRI scan
      • Abdominal x-ray
      • Angiography
      • Bleeding scan (tagged red blood cell scan)
      • Blood clotting tests
      • Capsule endoscopy (camera pill that is swallowed to look at the small intestine)
      • Colonoscopy
      • Complete blood count (CBC), clotting tests, platelet count, and other laboratory tests
      • Enteroscopy
      • Sigmoidoscopy
  • References
    • Jensen DM. GI hemorrhage and occult GI bleeding. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 137.

      Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 19.