Gastrointestinal Bleeding

Bleeding in the digestive tract is a symptom of a disease rather than a disease itself. Bleeding can occur as the result of a number of different conditions, some of which are life threatening. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says most causes of bleeding are related to conditions that can be cured or controlled, such as ulcers or hemorrhoids. (Read about "Peptic Ulcers" "Hemorrhoids") The American College of Gastroenterology (ACG) says ulcers are the most common cause of bleeding in the digestive system. The cause of bleeding may not be serious, but locating the source of bleeding is important.

Bleeding can come from anywhere in the digestive system (Read about "Digestive System"), from a small area such as an ulcer on the lining of the stomach or from a large surface such as an inflammation of the colon or even colorectal cancer. (Read about "Colorectal Cancer")

Bleeding is not something to be ignored. Bleeding can sometimes occur without the person noticing it. This type of bleeding is called occult or hidden. Fortunately, simple tests can detect occult blood in the stool.

Some of the more common causes of bleeding according to NIDDK are:

• Esophagus
  • inflammation (esophagitis)
  • enlarged veins (varices)
  • tear (Mallory-Weiss syndrome)
  • cancer (Read about "Esophagus Cancer")
• Stomach
  • ulcers (Read about "Peptic Ulcers")
  • inflammation or gastritis (Read about "Gastritis")
  • cancer (Read about "Stomach Cancer")
• Small intestine
  • duodenal ulcer
  • inflammation (Read about "Crohn's Disease")
• Large intestine and rectum
  • hemorrhoids (Read about "Hemorrhoids")
  • infections (Read about "Microorganisms")
  • inflammation (Read about "Ulcerative Colitis")
  • colorectal polyps (Read about "Colon Polyps")
  • colorectal cancer (Read about "Colorectal Cancer")
  • diverticular disease (Read about "Diverticular Disease")
  • arteriovenous malformations (AVM)

The symptoms of bleeding in the digestive tract depend upon the site and severity of bleeding. If blood is coming from the rectum or the lower colon, bright red blood will coat or mix with the stool. The stool may be mixed with darker blood if the bleeding is higher up in the colon or at the far end of the small intestine. When there is bleeding in the esophagus, stomach, or duodenum, the stool is usually black or tarry. Vomited material may be bright red or have a coffee-grounds appearance when one is bleeding from those sites. If bleeding is occult, the patient might not notice any changes in stool color.

If sudden massive bleeding occurs, a person may feel weak, dizzy or faint. (Read about "Syncope") They may also be short of breath or have crampy abdominal pain or diarrhea. (Read about "Diarrhea") Shock may occur, with a rapid pulse, drop in blood pressure and difficulty in producing urine. (Read about "The Urinary System") The patient may become very pale. If bleeding is slow and occurs over a long period of time, a gradual onset of fatigue, lethargy, shortness of breath and pallor from the anemia will result. Anemia (Read about "Anemia") is a condition in which the blood's iron-rich substance, hemoglobin, is diminished. Locating the site of the bleeding is important. A doctor will usually take a complete medical history and perform a physical.

Symptoms such as changes in bowel habits, stool color (to black or red) and consistency, and the presence of pain or tenderness may tell the doctor which area of the GI tract is affected. The intake of iron, bismuth (found in many pink over-the-counter indigestion medications) or foods such as beets can give the stool the same appearance as bleeding from the digestive tract. That is one reason a doctor will probably test the stool for blood before offering a diagnosis. A blood count (Read about "Complete Blood Count") will indicate whether the patient is anemic and also will give an idea of the extent of the bleeding and how chronic it may be.

Diagnosis

Some of the methods used to diagnose the reason for the bleeding according to NIDDK include:

• Endoscopy is a common diagnostic technique that allows direct viewing of the bleeding site. The endoscope is a flexible instrument that can be inserted through the mouth or rectum. The instrument allows the doctor to see into the esophagus, stomach, duodenum, colon (colonoscopy) and rectum (sigmoidoscopy). (Read about "Endoscopy" "Colonoscopy" "Flexible Sigmoidoscopy") Endoscopy can also be used to collect small samples of tissue for biopsy. (Read about "Biopsy")
• Capsule endoscopy, also known as the camera pill, is a swallowable capsule containing a tiny camera that has Food and Drug Administration (FDA) approval. It takes pictures twice a second as it glides through the small intestine. It is then excreted from the body. It is intended to visualize the inside of the small intestine to detect polyps, cancer or causes of bleeding and anemia. (Read about "Colon Polyps" "Cancer: What It Is" "Anemia")
• Barium x-rays are considered less accurate than endoscopy in locating bleeding sites. (Read about "X-rays")
• Angiography is a technique that uses dye to highlight blood vessels.
• Radionuclide scanning is a noninvasive screening technique used for locating sites of acute bleeding, especially in the lower GI tract.

The last four techniques are especially useful when the small intestine is suspected as the site of bleeding since the small intestine may not be seen easily with endoscopy.

Treatment options

Endoscopy can be used for both diagnosis and treatment of GI bleeding. Chemicals can be injected directly into a bleeding site with a needle introduced through the endoscope. A physician can also cauterize, or heat, a bleeding site and surrounding tissue with a special device passed through the endoscope. Laser therapy can be used in some situations.

Once bleeding is controlled, medicines may be prescribed to prevent recurrence of bleeding. Medicines are useful primarily for H. pylori, esophagitis, ulcer, infections and irritable bowel disease. Medical treatment of ulcers, including the elimination of H. pylori, to ensure healing and maintenance therapy to prevent ulcer recurrence can also lessen the chance of recurrent bleeding, according to NIDDK.

Removal of polyps with an endoscope can control bleeding from colon polyps. Removal of hemorrhoids by banding or various heat or electrical devices can be used with patients who suffer frequent hemorrhoidal bleeding.

Endoscopic techniques do not always control bleeding. Sometimes angiography may be used. Surgery may be needed to control severe or recurrent bleeding if endoscopy is not successful.