Gastrointestinal Bleeding

What is Gastrointestinal Bleeding?

Gastrointestinal (GI) bleeding is a medical condition that occurs when there is bleeding in the digestive tract. The digestive tract comprises the oesophagus, stomach, small intestine, large intestine, rectum, and anus. It can happen anywhere in the digestive tract, from the oesophagus to the rectum. 

The blood can be bright red, maroon-coloured, or black and tarry. The amount of blood lost can vary from small to large, depending on the location and severity of the bleeding. 

Gastrointestinal bleeding can range from minor to severe and sometimes life-threatening. It is essential to seek medical attention if you experience symptoms of gastrointestinal bleeding, such as vomiting blood, passing black, tarry stools, or experiencing abdominal pain or cramping.

How Does Gastrointestinal Bleeding Impact Your Anatomy and Health?

When blood is lost, it can lead to anaemia, a condition with a deficiency of red blood cells. Anaemia can cause fatigue, weakness, shortness of breath, and other symptoms. In severe cases, gastrointestinal bleeding can lead to shock, a life-threatening condition.

Types of Gastrointestinal Bleeding

There are three types of gastrointestinal bleeding: upper gastrointestinal bleeding (UGIB), small bowel bleeding, and lower gastrointestinal bleeding (LGIB).

Upper Gastrointestinal Bleeding (UGIB):

UGIB refers to bleeding in the upper digestive tract, including the oesophagus, stomach, and the first part of the small intestine (duodenum). The most common causes of UGIB include:

• Peptic ulcers (sores in the stomach or duodenum)
• Oesophageal varices (swollen veins in the oesophagus)
• Mallory-Weiss tears (tears in the lining of the oesophagus)
• Gastritis (inflammation of the stomach lining)
• Cancer of the stomach or oesophagus
• Varices

Symptoms of UGIB include vomiting blood, dark, tarry stools, and abdominal pain.

Small bowel bleeding:

• Peptic ulcers (sores in the stomach or duodenum)
• Angioectasias/angiodysplasia/arteriovenous malformations (abnormal and fragile blood vessels that can bleed)
• Cancer of the small bowel

Lower Gastrointestinal Bleeding (LGIB):

LGIB refers to bleeding in the lower part of the digestive tract, including the colon, rectum, and anus. The most common causes of LGIB include:

• Diverticulosis (small pouches in the colon that can become inflamed)
• Haemorrhoids (swollen veins in the rectum or anus)
• Inflammatory bowel disease (IBD) (including ulcerative colitis and Crohn's disease)
• Colorectal cancer

Who Does Gastrointestinal Bleeding Affect?

Anyone can experience gastrointestinal bleeding, but certain factors can increase the risk. These include:

• Age: Gastrointestinal bleeding is more common in older adults.
• Medical conditions: People with certain medical conditions, such as liver disease, inflammatory bowel disease, or cancer, are at higher risk for gastrointestinal bleeding.
• Medications: Certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and blood thinners (warfarin, direct oral anticoagulants (DOACs), clexane), can increase the risk of gastrointestinal bleeding.
• Alcohol use: Heavy alcohol use can increase the risk of gastrointestinal bleeding.

Causes of Gastrointestinal Bleeding

The causes of GI bleeding can vary depending on the location of the bleeding. Here are some common causes of GI bleeding:

Peptic Ulcers

Peptic ulcers are sores that develop in the stomach lining or duodenum. These ulcers can cause bleeding when they erode through a blood vessel.

Oesophageal Varices

Oesophageal varices are swollen veins in the oesophagus that can occur in people with liver disease. These veins can rupture and cause significant bleeding.

Gastritis

Gastritis is inflammation of the stomach lining. This inflammation can lead to erosions in the stomach lining, which can cause bleeding.

Diverticulosis

Diverticulosis is a condition where small pouches form in the colon. These pouches can become inflamed and bleed.

Haemorrhoids

Haemorrhoids are swollen veins in the rectum or anus. These veins can bleed when they are irritated or during a bowel movement.

Colorectal Cancer

Colorectal cancer is cancer that starts in the colon or rectum. This cancer can cause bleeding when the tumour erodes through a blood vessel.

Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease, including Crohn's disease and ulcerative colitis, can cause inflammation and ulcers in the digestive tract, which can lead to bleeding.

Symptoms of Gastrointestinal Bleeding

The symptoms of gastrointestinal bleeding can vary depending on the location and severity of the bleeding. Some of the most common symptoms include:

• Vomiting blood or coffee ground-like material
• Black or tarry stools
• Bright red blood in the stools
• Abdominal pain or cramping
• Weakness or lightheadedness
• Shortness of breath
• Rapid heart rate

It is essential to seek medical attention immediately if you experience any of these symptoms, especially if you have a history of gastrointestinal bleeding or are taking medications that can increase the risk of bleeding.

Stages Of Gastrointestinal Bleeding

There are no stages of Gastrointestinal bleeding. 

The bleeding can be considered mild to severe based on the amount of blood loss, the location of the bleeding, and the rate of blood loss.

Mild bleeding involves a small amount of blood loss and can sometimes go unnoticed. Moderate bleeding involves more blood loss and can cause fatigue and weakness. Severe bleeding is a life-threatening emergency that requires immediate medical attention and can cause shock and other painful symptoms.

How is Gastrointestinal Bleeding Diagnosed?

GI bleeding can be diagnosed through various tests and procedures, depending on the location and severity of the bleeding. Here are some common methods used to diagnose GI bleeding:

Physical Exam

Your doctor will perform a physical exam and ask about your medical history, symptoms, and any medications you are taking.

Blood Tests

Blood tests can help detect anaemia (low red blood cell count) and other signs of bleeding.

Stool Tests

Stool tests can detect the presence of blood in the stool.

Endoscopy

Endoscopy is a procedure that uses a flexible tube with a camera on the end to examine the digestive tract. Depending on the location of the bleeding, your doctor may perform an upper endoscopy (to examine the oesophagus, stomach, and duodenum) or a lower endoscopy (to examine the colon and rectum). An enteroscopy can examine the small bowel.

Barium X-ray

A barium X-ray involves swallowing a liquid that coats the digestive tract, followed by X-rays to help detect any abnormalities.

CT Scan or MRI

Computed tomography (CT) scan and magnetic resonance imaging (MRI) can detect the location and severity of bleeding.

Angiography

Angiography involves injecting dye into the blood vessels to detect the location of the bleeding.

How is Gastrointestinal Bleeding Treated?

Gastrointestinal bleeding can be effectively treated depending on the related cause and underlying diagnosis. The treatment for GI bleeding depends on the cause and severity of the bleeding. Here are some standard methods used to treat GI bleeding:

Blood transfusions

If the bleeding has caused significant blood loss, you may need a blood transfusion to replace the lost blood.

Medications

Medications may be prescribed to stop the bleeding or to prevent further bleeding. For example, proton pump inhibitors (PPIs) can help reduce the amount of acid in the stomach, which can help heal ulcers.

Endoscopy

Endoscopy can be used for diagnosis and treatment. Your doctor may perform a procedure called endoscopic hemostasis to stop the bleeding. This involves using tools passed through the endoscope to apply heat, electricity, mechanical clips, or medication to the bleeding site.

Surgery

In severe cases, surgery may be necessary to stop the bleeding. If a tumour or other abnormal growth causes bleeding, surgery may be needed to remove it.

Treatment of underlying conditions

If the GI bleeding is caused by an underlying condition, such as inflammatory bowel disease, treating the underlying condition may help stop the bleeding.

What if Gastrointestinal Bleeding is Untreated?

If left untreated, gastrointestinal bleeding can have serious consequences. The bleeding may stop on its own in mild cases, but in more severe cases, it can lead to anaemia, shock, and even death.

Untreated gastrointestinal bleeding can also lead to long-term complications, such as scarring or narrowing of the digestive tract, which can cause difficulty swallowing or chronic diarrhoea.

If you experience any symptoms of gastrointestinal bleeding, it is essential to seek medical attention immediately. 

Early diagnosis and treatment can help prevent serious complications and improve long-term health outcomes. If you are at risk of gastrointestinal bleeding or have a history of the condition, talk to a gastroenterologist about screening and management options.