Gastrointestinal Bleeding

Your gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum and anus. Bleeding can come from one or more of these areas. Gastrointestinal bleeding may occur in the upper or lower gastrointestinal tract.

In the upper GI tract, which includes the lining of the esophagus, stomach, or upper portion of the small intestines (duodenum), bleeding most often is caused by:

  • Peptic ulcers
  • Gastritis
  • Esophageal varices
  • Mallory-Weiss tears

In the lower tract, which includes the large intestine and rectum, bleeding may be caused by:

  • Polyps
  • Hemorrhoids and fissures
  • Small out-pockets in the wall of the colon (Diverticulosis)
  • Abnormal blood vessels in the lining of the intestines (angiodysplasia)
  • Inflammatory Bowel Diseases (IBD) which includes Crohn’s and Ulcerative Colitis
  • Infectious diarrhea
  • Various cancers (colon, small intestines, stomach, polyps).

GI bleeding is different depending on the location of the bleeding. If the bleeding is in the upper GI tract, it may include:

  • Vomiting bright red blood
  • Dark clots that look like coffee grinds

GI bleeding in the lower GI tract may include:

  • Streaks of blood on the stool
  • Small amounts of blood in the toilet or toilet paper
  • Large amounts of blood passed from the rectum

Causes

Causes for the gastrointestinal bleeding may vary. Stomach acid may irritate the esophagus, and cause bleeding. Vomiting may tear the lining of the esophagus, or abnormal veins may be present when there is a problem with the liver. Bleeding in the stomach and upper intestines may be caused by ulcers, an infection, or certain medications.

The lining of the rectum and large intestine may be injured when trying to pass a large stool, which may then result in bleeding. Also, if a child has colitis, the ulcers in the lower gastrointestinal tract may break blood vessels resulting in bleeding.

Diagnostic Tests

Various diagnostic tests are available:

  • Upper Or Lower Endoscopy can be used to evaluate GI bleeding and is the procedure of choice for a diagnosis; and sometimes used in emergency cases.
  • Capsule Endoscopy – may be done to diagnose bleeding in the area of the gastrointestinal tract that the endoscopy or colonoscopy is unable to reach.
  • Where endoscopy is non-diagnostic, a bleeding scan, Mickel’s Diverticulum Scan, Capsule Endoscopy or Angiogram can be used.

Treatment

Upper endoscopy and/or colonoscopy are used to identify the source of bleeding. Injection, sclerotherapy, electrocoagulation, vascular clipping and biopsy may be performed. Upper bleeding may be treated with medications such as Zantac, Pepcid, Prevacid, Prilosec, etc. to help reduce the stomach’s acidity until it has a chance to heal.

Lower gastrointestinal bleeding from hemorrhoids, can be modified by managing the diet and using stool softeners and creams; or they can be removed by a doctor during a colonscopy procedure (Polypectomy). Certain medications can be prescribed to manage the inflammation of colitis. Cauterization (a method in which a hot tool is placed on the tissue to stop bleeding) can also be done to stop bleeding of the blood vessels on the surface of the digestive tract.