Bleeding in the Digestive Tract

To successfully treat bleeding in the digestive tract, it is important to identify the cause and locate the source of bleeding.

Conditions that can cause GI bleeding include:

• Abnormal or enlarged blood vessels in your GI tract (angiodysplasia)
• Benign tumors or malignant cancer in the esophagus, stomach, colon, or rectum
• Colon polyps
• Crohn’s disease (inflammatory bowel disease)
• Diverticulosis and diverticulitis
• Esophageal varices (abnormal, enlarged veins in the esophagus)
• GERD
• Gastritis (inflammation of the stomach)
• Hemorrhoids
• Mallory-Weiss tears (tears in the lining of the esophagus)
• Peptic ulcers
• Ulcerative colitis (inflammatory bowel disease)

Symptoms of GI bleeding depend on the location and amount of bleeding.

In the upper GI tract symptoms may include:

• Bright red blood in vomit
• Vomit that looks like coffee grounds
• Black or tarry stool
• Dark blood mixed with stool
• Stool mixed or coated with bright red blood

In the lower GI tract symptoms may include:

• Black or tarry stool
• Dark blood mixed with stool
• Stool mixed or coated with bright red blood

Bleeding in the GI tract may be acute or chronic. Acute bleeding (severe bleeding that occurs suddenly) is a serious condition that requires immediate treatment.  Symptoms may include:

• Weakness
• Dizziness
• Shortness of breath
• Abdominal pain / cramps
• Diarrhea
• Paleness

Acute bleeding can cause a person to go into shock, which is characterized by a rapid pulse, sudden decrease in blood pressure, difficulty urinating, and eventually unconsciousness.

Chronic bleeding occurs over a long period of time and may cause anemia, which leads to fatigue and shortness of breath over time.

To diagnose the cause of bleeding in the digestive tract, the gastroenterologist must determine where it is coming from. The doctor will take your medical history, perform a physical examination, and ask you about any symptoms you may be having, such as black or red stools, vomiting, or changes in bowel habits. If you feel any pain or tenderness in the abdomen during the examination, this may help the doctor identify which area of the GI tract is bleeding.

The doctor will likely order one or more diagnostic tests. These may include:

• Stool test to check for blood in the stool
• Blood work to check for anemia and the extent of bleeding
• Gastric lavage to help determine whether the bleeding is in the upper or lower GI tract
• Endoscopy to view the inside of the GI tract

Endoscopy is the most common approach. During an endoscopy, the doctor can also obtain biopsies, or samples, of any tissues that look abnormal. There are a number of different types of endoscopy:

Types of Endoscopy

To check the upper GI tract, the doctor will insert the endoscope through the mouth. This is called an upper endoscopy or EGD, which is short for esophagogastroduodenoscopy.

To check the lower GI tract, the doctor will insert the endoscope through the rectum. This procedure is known as a colonoscopy.

During an enteroscopy, the doctor uses a special, longer endoscope to view the small intestine.

Capsule endoscopy is another method to locate bleeding in the small intestine. In the doctor’s office, you will swallow a capsule that contains a tiny camera. As the capsule passes through your digestive tract, it takes two pictures per second. These images are transmitted to a receiver you wear, which you will turn in when you return to the office after 8 hours. The doctor will then download the images to search for signs of bleeding. You will eventually eliminate the capsule through a bowel movement.

If the doctor suspects that your bleeding is in the lower part of your colon (the sigmoid colon), he or she may perform a flexible sigmoidoscopy. A sigmoidoscope is inserted through your rectum to check for and treat any bleeding.

Imaging Tests

Your gastroenterologist may also use one or more imaging tests to locate the source of your bleeding. These may include:

• Abdominal CT scan
• Angiogram: A contrast dye is injected into a vein to make blood vessels in the GI tract visible during an X-ray or CT scan. The dye leaks out at the site of bleeding.
• Barium X-rays: Barium is a contrast solution that helps make the GI tract visible during an X-ray. To view the upper GI tract, you will swallow the barium. To view the lower GI tract, it will be inserted as an enema through your rectum.
• Radionuclide scan: A small amount of a radioactive material is injected into a vein, which helps create images of blood flow in the GI tract.

If these noninvasive methods fail to locate the source of GI bleeding, your doctor may need to perform a surgical procedure called exploratory laparotomy to examine the digestive tract.

Endoscopy may be used not only to diagnose GI bleeding but also to treat it. Using tools inserted through the endoscope, the doctor can:

• Inject chemicals into the bleeding site
• Treat the bleeding site and surrounding tissue with a heat probe, electric current, or laser
• Close affected blood vessels with a band or clip

Angiography can also be used to treat certain types of GI bleeding. During the procedure, a radiologist will inject medicine into the affected blood vessels to stop the bleeding.

If endoscopy and angiography do not work, the patient may need other treatments or surgery to stop the bleeding.

Once the underlying cause of bleeding is identified, your doctor can treat the condition to prevent bleeding in the future. Conditions such as H. pylori and peptic ulcers can often be treated and managed with medication.