Gastrointestinal Bleeding

What is gastrointestinal bleeding?

Gastrointestinal (GI) bleeding occurs when there is bleeding in the GI system, which includes the esophagus, stomach, small intestines, colon (large intestines), rectum, and anus. Upper and lower GI hemorrhage are the two main categories into which GI bleeding is commonly divided. The esophagus, stomach, and a portion of the small intestine make up the upper GI tract; the colon, rectum, and anus make up the lower GI tract.

It may not always be noticeable in feces or vomit because the bleeding could be minor. Depending on the volume of blood lost and the disease producing the bleed, GI bleeds may or may not be dangerous. Small, ongoing bleeding, however, has the potential to cause considerable blood loss over time.

Risk Factors and Causes

Risk factors that may lead to GI bleeding include:

• Chronic vomiting
• Alcoholism
• Medications, including but not limited to
  • Non-steroidal anti-inflammatories (NSAIDs); commonly used NSAIDs include
    • Aspirin
    • Ibuprofen (Advil)
    • Naproxen (Aleve)
  • Anticoagulants
• Gastrointestinal surgery

Causes of minor bleeds are:

• Hemorrhoids
• Anal fissures or tears

Causes of more serious bleeds include:

• Ulcers
• Cancer (anywhere along GI tract)
• Polyps
• Inflammation in the GI tract (i.e. esophagitis, gastritis, colitis)
• Variceal bleeding, typically caused by liver damage
• Inflammatory bowel disease
  • Crohn’s disease
  • Ulcerative colitis
• Angiodysplasia
• Diverticulosis
• Meckel’s diverticulum
• Mallory-Weiss tears (tears in esophagus or upper stomach)
• Trauma

Symptoms

The location and source of the GI bleed will affect the symptoms, and lab testing are the only way to identify tiny GI bleeding. Manifested signs include

• Blood on toilet paper
• Red, bloody stools
• Black or tarry stools
• Red, bloody vomit
• Vomit that looks like coffee grounds

Other symptoms may include

• Weight loss
• Abdominal cramps
• Dehydration
• Fever
• Anemia
• Low blood pressure
• Fainting

Other symptoms, such as jaundice or a yellowing of the skin in the case of liver injury, may also exist depending on the origin of the GI bleed.

Diagnosis

To identify the origin and source of bleeding, the following tests may be carried out:

• Endoscopy (procedure involving a camera to look at the inside of the GI tract); a subtype is colonoscopy
• Angiography (X-ray with contrast agent to visualize blood vessels)
• Ultrasound
• CT scan
• MRI
• Complete blood count
• Hemoglobin levels
• Electrolyte levels
• Coagulation (blood clotting) tests

Treatments

There are numerous ways to treat GI bleeding.  Using x-ray guidance, a number of wires, and tubes, an interventionalist will travel to the location of concern after first acquiring vascular access in the groin through the femoral artery. Different methods can now be utilized to halt the bleeding.  To occlude an artery, small particles or wire coils can be inserted into it.  Another approach is to inject drugs directly into the vessel that is bleeding in an effort to stop the bleeding. These drugs force the arteries to contract.  On rare occasions, a stent will be inserted into the bleeding site's wall. For more details, visit our embolization and stent graft placement pages.