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GI bleeding, bleeding in the gut, gastrointestinal haemorrhage
gastrointestinal (GI) bleeding describes any blood loss that occurs through the digestive tract.
What is going on in the body?
The GI or digestive tract is a passage that leads from the mouth to the anus. This tract also includes the:
Bleeding can occur anywhere in the GI tract due to various conditions.
- oesophagus, a tube that connects the mouth to the stomach
What are the signs and symptoms of the condition?
Mild cases of bleeding may cause no symptoms at all. When symptoms are present, they are related to the cause of blood loss, as well as the amount and location of the blood loss. Common symptoms include: Other symptoms are often related to the cause. For example: What are the causes and risks of the condition?
There are many possible causes of this condition, including:
Other causes are also possible. Sometimes, no cause can be found.
- peptic ulcer, which may occur in the stomach or small intestine
- gastritis, or inflammation of the lining of the stomach. This often occurs in those who have been using aspirin or analgesics called non-steroidal anti-inflammatory drugs (NSAIDs). gastritis is also common in a person who is alcohol dependent.
- enlarged veins in the oesophagus called oesophageal varices, which are prone to rupturing. This condition is usually seen as a part of alcoholic liver disease.
- a Mallory-Weiss tear, which is a small tear in the inside lining of the oesophagus, usually due to severe retching or vomiting
- diverticulosis, a condition that causes outpouchings of the walls of the colon
- infections in the gut, such as certain forms of infection-related diarrhoea, or diverticulitis, an infection of the outpouchings that occur in diverticulosis
- cancers or tumours, such as bowel cancer, stomach cancer, or oesophageal cancer
- inflammatory bowel disease, a poorly understood condition that results in inflammation in the bowels
- haemorrhoids, which are enlarged veins around the anus
- abnormal blood vessels in the digestive tract, which may rupture
- inflammation of the bowel from a lack of blood flow, or from radiation therapy
What can be done to prevent the condition?
Avoidance of alcohol, aspirin, and NSAIDs can prevent cases due to these causes. Many cases cannot be prevented.
How is the condition diagnosed?
Bleeding in the GI tract may be discovered with a routine test of the stool for blood that is often part of a complete physical examination. In other cases, a person complains of blood in the stool. In some cases, the history and physical examination are all that is needed to determine the cause, such as with visible haemorrhoids.
In most cases, further testing is needed, and may include:
What are the long-term effects of the condition?
- a FBC, or full blood count
- endoscopy to locate the source of bleeding. This is a procedure that uses a thin tube with a light and camera on the end of it. The tube can be inserted into the mouth or anus and advanced into the GI tract. The camera on the end of the tube allows the doctor to see the inside lining of the GI tract.
- special x-ray tests or additional tests to detect bleeding
Heavy, rapid bleeding can result in shock or death. Most long-term effects are related to the cause of GI bleeding. For example, haemorrhoids may be painful, but rarely cause serious long-term effects. Cancer can cause death.
What are the risks to others?
GI bleeding is not contagious. In cases due to infections, the infection is sometimes contagious.
What are the treatments for the condition?
Those with heavy bleeding may need blood transfusions. Fluids may be given through an intravenous line, which is a thin tube inserted into a person's vein. Further treatment is often directed at the cause, if it can be determined. For example, those with:
What are the side effects of the treatments?
- ulcers may need medications to reduce stomach acid, such as ranitidine or omeprazole
- cancer may need surgery, chemotherapy, or radiation therapy
- an infection may need antibiotics
Side effects depend on the treatments used: What happens after treatment for the condition?
Some people may die even with treatment if the bleeding is heavy and cannot be stopped. This is not uncommon in those with bleeding from oesophageal varices. Some people are able to return to normal activities right away, such as most people with haemorrhoids.
How is the condition monitored?
Periodic FBC blood tests may be done to make sure the blood counts are stable. Many people with bleeding are briefly monitored for further bleeding in the hospital. Other monitoring is usually related to the cause. For example, those with a stomach ulcer may need a repeat endoscopy procedure in the future to make sure the ulcer is healing properly.
Author: Adam Brochert, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 12/06/2005
Potential conflict of interest information for reviewers available on request