Gastrointestinal Bleeding

What is Gastrointestinal Bleeding?

Gastrointestinal hemorrhage is bleeding within the gastrointestinal (GI) tract. It can be ominous and must be treated. It is divided into upper GI hemorrhage (esophagus and stomach) and lower GI hemorrhage (small and large intestine). The bleeding may be mild or severe. The death rate from GI hemorrhage is highest in the elderly. Upper gastrointestinal bleeding is frequently caused by esophageal or stomach ulcers; there are two ulcers fifteen percent of the time. Lower gastrointestinal hemorrhage is caused by lesions in the small intestine (rarely) or large bowel, colon or anorectum. The right and left colon are equally affected.

How is it diagnosed?

History: The individual will report vomiting of bright red blood or coffee-ground material and abdominal pain in the case of upper GI bleeding. The passage of dark or bright red blood in the stool or tarry black stools (melena) may be seen in lower GI bleeding. Lack of appetite, weight loss, fatigue, chest pain or dizziness (vertigo) may be present. Pertinent history includes any previous GI bleeding, changes in bowel habits, use of aspirin, other nonsteroidal antiinflammatory medication or alcohol.

Physical exam: A full history and physical will be done. Blood pressure (B/P) will be taken in lying, sitting and standing positions (orthostatic B/P measurement).

Tests: Blood tests may include complete blood count (CBC), type and cross match, creatinine and liver function tests. Upper GI x-ray using barium may be done. Gastroenteroscopy, anoscopy, sigmoidoscopy or colonoscopy may be performed. Nasogastric fluid, vomitus, and stool may be checked for blood.

How is GI bleeding treated?

Upper gastrointestinal hemorrhage treatment consists of hospitalization, blood or fluid replacement, insertion of a tube through the nose into the stomach (nasogastric or NG tube) and ice water or saline flushes of the stomach via the NG tube until the fluid returns clear. Bleeding areas may be cauterized during endoscopy. Surgery may be required if all other treatment fails or if blood loss is severe. Lower gastrointestinal hemorrhage is treated with blood or fluid replacement. A nasogastric tube may be inserted. Bleeding areas may be cauterized during a colonoscopy. Surgery may be required if the bleeding persists or recurs.

Medications

Pepcid (Famotidine), Prilosec (Omeprazole), Protonix (Pantoprazole)

What might complicate it?

The tissue of the gastrointestinal tract may break open (perforate) and cause infection. Blood loss may result in anemia or hemorrhagic shock. More than one area may be bleeding. Some individuals may refuse to have blood transfusions.

Predicted outcome

Bleeding stops spontaneously in 75% of all upper GI and 90% of all lower GI hemorrhages. Bleeding may recur until the underlying cause is treated. Surgical outcome depends on the surgery required.

Alternatives

Differential diagnoses include esophagitis, esophageal varices, peptic ulcer, portal hypertension, gastritis, ingestion of iron, bismuth or other foods which darken the stool, duodenal ulcer, chronic liver disease, valvular heart disease, arteriovenous malformations, scleroderma, mixed connective tissue disease, colon cancer, polyps of the colon, hemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease, and colitis.

Appropriate specialists

Gastroenterologist, internist, and radiologist.

Last updated 18 June 2015