Bleeding from any part of the gastrointestinal tract including esophagus, stomach, small intestine, large intestine (colon), rectum and anus. This symptom can be a life-threatening emergency.
GI bleeding first appears as blood in vomit or stool, black or tarry stools. It can be suspected if the person experiences abdominal pain, weakness, pale skin, shortness of breath, anemia. GI bleeding can be diagnosed by lab tests and procedures such as endoscopic procedures: esophagogastroduedonoscopy (EGD), gastroscopy, endoscopic ultrasound, sigmoidoscopy, or colonoscopy. The causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their location in the GI tract. Treatment depends on the cause or location of the bleeding and includes:
GI bleeding first appears as blood in vomit or stool, black or tarry stools. It can be suspected if the person experiences abdominal pain, weakness, pale skin, shortness of breath, anemia. GI bleeding can be diagnosed by lab tests and procedures such as endoscopic procedures: esophagogastroduedonoscopy (EGD), gastroscopy, endoscopic ultrasound, sigmoidoscopy, or colonoscopy. The causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their location in the GI tract. Treatment depends on the cause or location of the bleeding and includes:
- injecting medications/glues into the bleeding site (endoscopic injection, intravariceal cyanocrylate injection, angiographic embolization)
- "burning" (coagulating) the bleeding site and surrounding tissue with a heat probe, an electric current, or a laser (endoscopic thermal probe, argon plasma coagulation and radiofrequency ablation),
- closing affected blood vessels with a band or clip
The most common cause of upper GI bleeding is peptic ulcers caused by a bacterial (Helicobacter pylorii) infection (62% of all cases). It often happens after aspirin or nonsteroidal anti-inflammatory drug use and is associated with abdominal pain reduced with food consumption, and nocturnal symptoms. Second common cause (10% of cases) is araeriovenous malformations in older patients (bleeding is often painless, the patient has a history of iron deficiency anemia). Next common cause is gastritis and duodenitis (8%) followed by Esophageal varices (if history of cirrhosis and portal hypertension), Mallory-Weiss tear (history of repeated retching or vomiting), gastrointestinal malignancy (history of weight loss, smoking, or alcohol consumption; more common in Asians), Esophagitis or esophageal ulcer (Heartburn, indigestion, or dysphagia) and Dieulafoy ulcer (painless bleeding, more common in men). It could also happen because of inflammation of the GI lining from ingested materials. No identifiable source can be found in 8% of cases.
The most common causes of lower GI bleeding are diverticulitis, inflammatory bowel disease, gastrointestinal cancers, infectious diarrhea, angiodysplasia, polyps, hemorrhoids and anal fissures. The source of Occult Gastrointestinal Bleeding can be identified in 85%-90%, no bleeding sites will be found in about 5%-10% of cases.
Prevention techniques include healthy diet and eating habits (e.g. remaining upright after meals to avoid acid reflux), drinking plenty of water, reviewing aspirin treatment before starting it, preventing hemorrhoids by resisting the urge to strain when having a bowel movement, identifying and evaluating polyps.
