Symptoms, Causes, Diagnosis, and Treatment of Gastrointestinal Bleeding

Gastrointestinal Bleeding

Gastrointestinal bleeding or upper gastrointestinal bleeding refers to bleeding that occurs in the tissues of the esophagus, stomach, and duodenum. All blood losses developing in the esophagus, stomach, small intestine, along with the cecum, colon, and rectum are gastrointestinal (GI) bleedings. These bleedings can be in the form of minimal, recurrent mild, or severe blood loss. Gastrointestinal bleeding is not a disease by itself, but it is an important symptom. Gastrointestinal bleeding can be a harbinger of a serious health problem and may carry a life-threatening risk. In some cases, individuals may not realize that bleeding is occurring. This condition is defined as occult bleeding. Occult bleedings can be detected with additional tests such as a stool test. Bleeding symptoms may depend on the region where the bleeding occurs and its severity.

What is Gastrointestinal Bleeding?

Gastrointestinal bleeding is blood loss that develops in one or more tissues within the digestive system. GI bleedings may be indicators of disorders occurring in the digestive organs between the mouth and the anus. Classification according to the site where the bleeding occurs is as follows:

Upper gastrointestinal bleedings: This is the type of bleeding considered as gastrointestinal bleeding. It refers to bleedings occurring in the esophagus, stomach, and the first part of the small intestine (duodenum).

Small intestine bleedings: These are bleedings occurring in the middle (jejunum) and last (ileum) parts of the small intestine.

Lower gastrointestinal bleedings: These are bleedings occurring in the large intestine (cecum, colon, rectum) and anus.

Gastrointestinal bleeding can typically stem from damages in the tissues of the stomach, the first section of the small intestine, and the esophagus. The duration and pattern of gastrointestinal bleedings may vary. In this context, upper gastrointestinal bleedings are:

Acute: Severe bleedings that start suddenly and may indicate an urgent medical problem.

Chronic: Long-lasting, recurrent mild bleedings.

Occult: Bleedings that cannot be seen with the naked eye. They are detected by laboratory tests.

Overt: Bleedings that are visible through stool or vomiting. Bleeding can be in bright or dark colors.

Gastrointestinal bleeding can manifest itself through the mouth and the anus. In addition, in some cases, it can be detected by microscopic imaging methods and laboratory tests.

How Does Gastrointestinal Bleeding Occur?

Gastrointestinal bleeding and lower gastrointestinal bleedings can occur in different ways. Many internal and external factors can lead to gastrointestinal bleeding. Upper gastrointestinal bleedings, which encompass the esophagus, stomach, and the first section of the small intestine, are generally related to the following causes:

Esophagitis: Inflammation of the esophagus that can lead to bleeding and ulcers.

Peptic ulcer: Sores that develop in the stomach and duodenum.

Gastritis: Inflammations forming in the stomach lining/mucosa.

Gastroesophageal reflux disease (GERD): A health problem that develops as a result of stomach contents flowing back into the esophagus.

Varices: The formation of varices in the esophagus or stomach can result in bleeding.

Mallory-Weiss tears: Tears in the lower esophagus that can result in bleeding.

Benign tumors, esophageal cancer, stomach cancer, liver, and pancreatic cancer can lead to upper GI bleedings.

Lower gastrointestinal bleedings are frequently seen in conditions affecting the small and large intestines. In this case, it may not be classified as gastrointestinal bleeding. These may primarily be diverticulitis, ulcerative colitis, Crohn's disease, hemorrhoids, anal fissures, polyps (benign tumors), anal and colorectal cancers.

What Are the Symptoms of Gastrointestinal Bleeding?

When gastrointestinal bleeding is visible to the naked eye, it can be easily detected, and the source of the bleeding can be estimated. The tissue or organ affected by the bleeding can be taken into consideration by evaluating the speed of the bleeding, differences in stool color (red, black, etc.), changes in stool consistency, the location of tenderness and pain, and changes in diet and medication use. Overt bleedings can be in the form of vomiting blood that is bright red or dark brown and coffee-ground in consistency, black tarry stools, and rectal bleeding. Occult bleedings that cannot be seen with the naked eye may primarily manifest as dizziness, fainting, abdominal or chest pain, shortness of breath, fatigue, or weakness. Gastrointestinal bleeding can occur anywhere in the digestive tract from the mouth to the small intestine. Lower and upper GI, and small intestine bleedings can be distinguished by different characteristics. Common symptoms seen in upper GI bleedings include:

Vomiting bright red blood,

Vomiting material that looks like coffee grounds,

Dark colored blood mixed with stool,

Tarry stool consistency.

Depending on where the bleeding occurs, the blood may appear bright red or dark. Acute gastrointestinal bleeding refers to bleedings that start suddenly and can be severe. Severe acute gastrointestinal bleeding can bring along pale skin, sweating, rapid heartbeat, cold hands and feet, loss of consciousness, and can throw the person into shock.

How is Gastrointestinal Bleeding Diagnosed?

Diagnosis of gastrointestinal bleeding may include family history, medical history, and physical examination. The presence of current symptoms, medications used, surgical history, and existing health problems in the family are evaluated. During the physical examination, findings such as fever, pain and tenderness, presence of a mass, blood pressure, and heart rate are checked. Auxiliary tests may need to be performed to diagnose gastrointestinal bleeding. Some laboratory and imaging tests are resorted to for this purpose. There are recommended tests to determine the underlying cause of the bleeding and ensure appropriate treatment. These are:

Blood tests: Tests that help check the severity of the bleeding and whether anemia is present.

Stool tests: Involve examining the stool under laboratory conditions and provide information on whether occult bleeding is present.

Imaging tests: X-ray, computed tomography (CT), MRI can be used in the diagnosis of lower and upper GI problems.

Endoscopy: The procedure of viewing the esophagus, stomach, and duodenum with a camera-equipped endoscope device. In some cases, active bleeding can be treated during endoscopy. When endoscopy is used for the small intestine, it is called enteroscopy.

Capsule endoscopy: Whether there is bleeding in the small intestine is viewed by swallowing a capsule for a small camera.

Angiography: Enables blood vessels to be viewed with the help of X-rays by administering special dyes into the blood vessels.

In addition, radionuclide scanning, which can detect bleedings by injecting safe radioactive substances, may be preferred.

How is Gastrointestinal Bleeding Treated?

Gastrointestinal bleeding treatment is shaped depending on the cause, severity, and location of the blood loss. Identifying the underlying cause is important to stop the bleeding and prevent further blood loss. In some cases, the diagnostic and therapeutic method can be performed with the same method and at the same time. Drug therapy can be applied in bleedings caused by health problems such as ulcers, gastritis, GERD, and hemorrhoids. These medications can have properties that help alleviate symptoms, reduce stomach acid, and clot blood. Other main treatment methods may include:

Endoscopy: Encompasses upper gastrointestinal endoscopy, enteroscopy, and colonoscopy procedures. Injecting medication into the bleeding area, cauterizing bleeding blood vessels, applying bands and clips are treatment methods applied during endoscopy.

Angiography: Involves placing a catheter into a vessel to monitor the movement of blood within the blood vessels. The injection of medications or other substances to stop bleeding in certain areas can be provided.

Surgery: May be preferred when success cannot be achieved with other treatment methods. Generally, in severe bleedings, an attempt is made to stop blood loss with laparoscopic or open surgical methods. Gastrointestinal bleeding surgery may not be recommended for every individual.

Certain treatments and applications may be necessary to reduce the risk of bleeding after gastrointestinal bleeding. During the treatment and recovery process, be careful to use only the medications recommended by your doctor.

Frequently Asked Questions

Upper GI bleedings encompass acute forms of bleeding that start suddenly and are short-lived. They can generally be seen together with symptoms such as abdominal and chest pain, dizziness, fatigue, etc. Chronic gastrointestinal bleeding has a continuous or recurrent appearance that can last for a long time (several days or weeks). Since gastrointestinal bleeding is bleeding that develops in the digestive system and affects the tissues there, it falls under the Gastroenterology department. Gastrointestinal bleeding can occur in one or more regions (esophagus, stomach, small intestine) of the gastrointestinal system consisting of many organs. Depending on the underlying health problem, bleeding may start due to irritation, tearing, or ulcers in tissues and organs. Overt gastrointestinal bleeding can be seen with additional findings such as pain, tenderness, swelling, etc. in the gastrointestinal system. They are visible bleedings through vomiting or in the stool. Occult bleedings can only be detected with laboratory tests and may not show any symptoms. Gastrointestinal bleeding can be seen in any age group depending on the underlying causes. However, the risk of developing gastrointestinal bleeding may increase with aging. Therefore, the risk of experiencing gastrointestinal bleeding in the elderly may be higher compared to other age groups. In addition, the risk of gastrointestinal bleeding is higher in individuals with health problems that can lead to GI bleedings. Gastrointestinal bleeding in children can lead to fatal consequences, and medical intervention must be provided. In the presence of bleedings starting suddenly and seen with pain, dizziness, and loss of consciousness, emergency intervention must definitely be provided. Especially during acute bleedings that can lead to a state of shock, medical help should be sought as soon as possible in case of fast and irregular heartbeats, pale skin color, cold hands and feet, and sweating. The treatment duration for gastrointestinal bleeding can be correlated with the treatment plan of the health problem causing the bleeding. Short-term hospitalization or outpatient treatment can be applied for health problems and bleedings that can be controlled with medication therapy. However, individuals who have undergone endoscopy, laparoscopy, or open surgery may need to be hospitalized for several days to weeks. Contact your doctor for the most appropriate treatment method for you. GI bleedings can originate from any of the upper and lower digestive organs. Bleedings originating from the esophagus, stomach, and duodenum are forms of gastrointestinal bleeding and can manifest as bleeding through vomiting and stool. Bleeding seen in the stool can in some cases be other bleedings related to the lower digestive system. Stress can be directly or indirectly associated with gastrointestinal lesions such as gastric ulcers, erosions, gastritis, and duodenal ulcers. These GI lesions can lead to bleeding in upper system organs. Gastrointestinal bleeding from distress may not happen to everyone, but physical and emotional stress is linked to bleedings caused by gastrointestinal lesions. Gastritis may be among the causes of gastrointestinal bleeding. Gastritis, defined as inflammation of the stomach mucosa, can leave mild or severe damage on the lining. These damages can cause superficial cracks and ulcers. Especially Helicobacter pylori and alcohol consumption are among the common causes of gastritis. In addition, nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin can be a risk factor for gastrointestinal bleeding and gastritis. Gastrointestinal bleeding can occur through vomiting and defecating from the anus. Blood in the urine is related to the excretory system, not the digestive system. The excretory system consists of the kidneys, bladder, ureters, and urethra. Since blood in the urine can be linked to other health problems, contact your doctor.

If you are experiencing symptoms of gastrointestinal bleeding, it is of vital importance to consult an expert gastroenterologist without wasting time.

Contact us immediately to make an appointment from our Hisar Hospital Gastroenterology department.