What you need to know about gastrointestinal bleeding

Gastrointestinal (GI) bleeding is when bleeding occurs in any part of the gastrointestinal tract. GI bleeding itself is not a disease, but a symptom of any number of conditions.

The GI tract includes your oesophagus, stomach, small intestine, large intestine (colon), rectum and anus. Any presence of blood in the stool or in vomit needs to be evaluated in the emergency department. Black or dark stools may represent slow bleeding and should be treated by a doctor.

You may initially be diagnosed with gastrointestinal (GI) bleeding and will likely be referred to a gastroenterologist, a specialist in the digestive tract.

The outcome of treatment depends on several factors:

• The cause and location of the bleeding
• The rate of bleeding when the person sees a doctor
• Prior health problems and conditions
• Maintenance of a proper diet and taking medication as directed

GI bleeding can usually be diagnosed by a digital rectal exam, an endoscopy or colonoscopy, and lab tests.

An endoscopy refers to the passage of a tube with a tiny camera through the rectum into the colon, to directly see the source of bleeding. Treatment usually includes hospitalisation because blood pressure may drop and the heart rate may increase.

A colonoscopy is the passage of a tube with a tiny camera through the rectum into the colon. In some cases, IV fluids or blood transfusions are needed, and surgery may be required.

Lab tests, such as full blood count, serum chemistries, liver tests and coagulation studies can be helpful to determine the rate or severity of bleeding.

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Signs and symptoms

Acute GI bleeding will first appear as vomiting of blood, bloody bowel movements, or black, tarry stools. Vomited blood may look like “coffee grounds.”

Symptoms can include:

• Fatigue
• Weakness
• Shortness of breath
• Abdominal pain
• Pale appearance

Vomiting of blood usually originates from an upper GI source. Bright red or maroon stool can be from either a lower GI source or from brisk bleeding from an upper GI source.

Long-term GI bleeding may go unnoticed or may cause fatigue, anaemia, black stools, or a positive test for microscopic blood.

The causes and risk factors are classified into upper or lower.

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Causes of upper GI bleeding

• Peptic ulcer disease: Peptic ulcers are localised erosions of the mucosal lining of the digestive tract. Breakdown of the mucosal lining results in damage to blood vessels, causing abdominal bleeding.

• Gastritis: General inflammation of the stomach lining, which can result in bleeding. It also results from an inability of the gastric lining to protect itself from the acid it produces. Causes include nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin, steroids, alcohol; and burns and trauma to the abdomen.

• Oesophageal varices: The swelling of the veins of the oesophagus or stomach commonly occur in alcoholic liver cirrhosis. The bleeding can be massive and occur without warning.

• Mallory-Weiss tear: A tear in the oesophageal or stomach lining, often as a result of severe vomiting or retching or after seizures; forceful coughing or laughing; lifting; or childbirth. Physicians often find tears in people who have binged on alcohol.

• Cancer: One of the earliest signs of oesophageal or stomach cancers may be blood in the vomit or stool.

• Inflammation: When the mucous membranes break down, they are unable to counteract the harsh effects of stomach acid. NSAIDs, aspirin, alcohol, and cigarette smoking promote gastric ulcer formation.

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Causes of lower GI bleeding

• Diverticulosis: One of the most common causes of lower GI bleeding. Small out-pockets form in the wall of the large intestine, usually in a weakened area of the bowel wall. The patient may develop several pockets, which are more common in people who have constipation and strain during a bowel movement.

• Cancers: One of the early signs of colon or rectal cancers may be blood in the stool. Inflammatory bowel disease

• (IBD): Flares of inflammation from IBD (Crohn’s disease and ulcerative colitis) often cause mucousy stool that has blood in it.

• Infectious diarrhoea: Some viruses or bacteria can cause damage to the inner lining of the intestines, which can lead to bleeding.

• Angiodysplasia: Another of the most common causes of lower GI bleeding, this is a malformation of the blood vessels in the wall of the GI tract. These are most commonly in the large intestine and often bleed. The elderly and people with chronic kidney failure develop the disease most often.

• Polyps: Intestinal polyps are noncancerous tumours of the GI tract, occurring mostly in people 40 years and older. A small proportion of these polyps may transform into cancer. Colon polyps may bleed rapidly, or they may bleed slowly and go undetected.

• Haemorrhoids and fissures: Haemorrhoids are swollen veins in and around the anus. Repeated stretching from straining during bowel movements causes them to bleed. Bleeding is usually mild, intermittent and bright red.

Anal fissures, or tears in the anal wall, also may trigger small amounts of bright red bleeding from the anus. Forceful straining during passage of hard stool usually causes such tears, which can be very painful and may require surgery.

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Treatment

It is important to know that there is no home care for heavy gastrointestinal bleeding. A person should go to a hospital’s emergency department if they have heavy GI bleeding.

Haemorrhoids or anal fissures may be treated with a diet high in fibre and fluids to keep stools soft. Serious GI bleeding can destabilise the vital signs of a patient. The patient’s blood pressure may fall sharply and their heart rate may increase.

The doctor may need to resuscitate the patient with intravenous (drip) fluids and possibly a blood transfusion. In some cases, the patient may need surgery.

Patients may be given intravenous acid suppressors such as omeprazole (Prilosec)

If a large amount of blood is in the upper GI tract, they may be given medications that help clear the stomach of blood, clots or food residue before an endoscopy procedure to clear the stomach.

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