Gastrointestinal Bleeding
Gastrointestinal (GI) bleeding refers to bleeding that occurs anywhere in the digestive tract — from the mouth to the anus. The bleeding may appear as fresh red or coffee-colored blood in vomit or as red, maroon, or black-colored blood in stool, depending on the source and amount of blood loss.
Common Causes of Gastrointestinal Bleeding:
GI bleeding is generally classified as upper or lower depending on the site of origin.
Upper GI Bleeding:
This includes bleeding from the esophagus, stomach, or duodenum.
Esophageal causes:
- Mallory-Weiss tear (tear in the esophageal lining due to vomiting)
- Esophageal varices (swollen veins due to liver disease)
- Esophagitis (inflammation of the esophagus)
- Esophageal ulcer
- Esophageal cancer
- Hiatus hernia with Cameron ulcers
Gastric causes:
- Gastric ulcer
- Gastric cancer
- Gastric varices
- Gastritis or gastropathy
- Dieulafoy’s lesion (abnormal blood vessel in the stomach)
- Gastric antral vascular ectasia (GAVE), also known as “watermelon stomach”
Duodenal causes:
- Duodenal ulcer
- Duodenal tumor
Lower GI Bleeding:
This includes bleeding from the small intestine, colon, or anal canal.
Anal canal causes (bright red blood):
- Hemorrhoids (piles)
- Anal fissure
Colonic causes:
- Colonic ulcers due to infection or inflammatory bowel disease (IBD)
- Colonic polyps or colorectal cancer
- Angiodysplasia (fragile blood vessels in the colon)
- Diverticular bleeding
Small intestine causes:
- Angiodysplasia or telangiectasia
- Small intestinal tumors
- Meckel’s diverticulum
- Ulcerations in the small intestine
Management of GI Bleeding:
Treatment depends on the severity and source of the bleeding.
- Severe or active bleeding: Patients should be hospitalized and treated with blood transfusions or plasma expanders to stabilize their condition.
- Mild or chronic bleeding: Can be evaluated and managed in an outpatient setting.
Initial diagnostic tests include:
- Upper GI endoscopy
- Colonoscopy
If these are inconclusive, further tests such as CT enterography, CT angiography, capsule endoscopy, or double-balloon enteroscopy may be done to find the bleeding source.
Treatment options depend on the identified cause and may include:
- Endoscopic ligation for esophageal varices
- Clipping or Argon Plasma Coagulation (APC) for ulcers or vascular lesions
- Surgical intervention for tumors or malignancies