1. Gastrointestinal Bleeding
Gastrointestinal Bleeding Overview
The many causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their
location in the GI tract.Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the
GI tract—the esophagus, stomach, or duodenum (first part of the intestine). Bleeding can come from
ingestion of caustic poisons or stomach cancer. Most often, upper GI bleeding is caused by one of the
following:
Peptic ulcers
Gastritis
Esophageal varices
Mallory-Weiss tears
Lower gastrointestinal bleeding: Lower GI bleeding originates in the portions of the GI tract farther down
the digestive system—the segment of the small intestine farther from the stomach, large intestine,
rectum, and anus. Diverticular disease, angiodysplasia, polyps, hemorrhoids, and anal fissures most
commonly cause the bleeding. Blood in the stool can result from cancers, inflammatory bowel disease,
and infectious diarrhea.
Gastrointestinal Bleeding Causes
The many causes of gastrointestinal bleeding are classified into upper or lower, depending on their
location in the GI tract.
Upper GI bleeding
Peptic ulcer disease: Peptic ulcers are localized erosions of the wall of the digestive tract. Ulcers usually
occur in the stomach or duodenum. Breakdown of the walls results in damage to blood vessels, causing
bleeding. When the mucous membranes break down, they are unable to counteract the harsh effects of
stomach acid. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, and cigarette smoking
promote gastric ulcer formation. Helicobacter pylori are a type of bacteria that also promote formation of
ulcers.
Gastritis: General inflammation of the stomach wall, which can result in bleeding. Gastritis also results
from an inability of the gastric lining to protect itself from the acid it produces. NSAIDs, steroids, alcohol,
burns, and trauma can cause gastritis.
Esophageal varices: Swellings in veins of your esophagus or stomach usually result from liver disease.
Varices most commonly result from alcoholic liver cirrhosis. When varices bleed, the bleeding can be
massive and catastrophic and occur without warning.
Mallory-Weiss tear: A tear in the esophageal or stomach wall, often as a result of vomiting or retching.
Tears also can occur after seizures, forceful coughing or laughing, lifting, straining, or childbirth.
Physicians often find tears in people who have recently binged on alcohol.
Lower GI bleeding
Diverticulosis: One of the most common causes of lower GI bleeding. Small out-pockets, or diverticula,
form on part of the wall of your colon (large intestine), usually in a weakened area of the bowel wall. You
may develop several pockets, which are more common in people who have constipation and strain at
stool.
Angiodysplasia: Along with diverticulosis, this is one of the most common causes of lower GI bleeding.
Angiodysplasia is a malformation in the blood vessels in the wall of the GI tract. The sores are most
common in the large intestine and often bleed. The elderly and people with chronic kidney failure develop
the disease most often.

2. Polyps: Intestinal polyps are noncancerous tumors of the GI tract, occurring mostly in people older than
40 years. A small proportion of these polyps may transform into cancer. Colonic polyps may bleed rapidly,
or they may bleed slowly and go undetected.
Hemorrhoids and fissures: Hemorrhoids are swellings of veins in and around your rectum. Repeated
stretching from straining at stool causes them to bleed. Bleeding from hemorrhoids is usually mild,
intermittent, and bright red. Massive bleeding is rare. 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.
Gastrointestinal Bleeding Symptoms
Acute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements, or black,
tarry stools. Blood may look like "coffee grounds." Symptoms associated with blood loss can include the
following:
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 at an upper GI source.
Long-term GI bleeding may go unnoticed or may cause fatigue, anemia, black stools, or a positive test for
microscopic blood.
When to Seek Medical Care
Any presence of blood in the stool or the upper gastrointestinal tract is significant and needs medical
investigation. Black or dark stools may represent slow bleeding into the GI tract and should be
investigated by a physician.
Any significant bleeding into the GI tract, either vomited blood or blood through the rectum, should be
evaluated in the emergency department.
Exams and Tests
A doctor will perform a complete history and physical exam to evaluate your problem. The physical will
include a digital rectal exam, to test for visible or microscopic blood from your rectum.
The doctor may need to insert a tube through your nose into your stomach to help identify the source of
the bleeding. The procedure is called endoscopy. An endoscope is a long tube with a tiny camera on the
end. It may be passed through the nose into the stomach, or through the rectum into the colon, to directly
see the source of bleeding. Endoscopy can be both diagnostic, finding the source of bleeding, and
therapeutic, stopping it.
Lab tests also can be helpful to determine the rate or severity of bleeding and to determine factors that
may contribute to the problem.
Gastrointestinal Bleeding Treatment
Self-Care at Home
There is no home care for heavy gastrointestinal bleeding. Go to a hospital’s emergency department. For
hemorrhoids or anal fissures, eat a diet high in fiber and fluids to keep stools soft.
Medical Treatment
Serious gastrointestinal bleeding can destabilize your vital signs. For instance, your blood pressure may
fall sharply and your heart rate will increase.
The physician may need to resuscitate you with IV fluids and possibly a blood transfusion.
In some cases, you may need surgery.

3. Next Steps Follow-up
Maintain a proper diet and take the medications prescribed to you as your doctor directs.
Follow up with your physician on a regular basis to monitor progress, so that your doctor can prevent
further progression and complications of your gastrointestinal bleeding.
Prevention
You can prevent some causes of gastrointestinal bleeding.
Avoid foods and factors, such as alcohol and smoking, that increase gastric secretions.
Eat a high-fiber diet to increase the bulk of the stool, which helps prevent diverticulosis and hemorrhoids.
Outlook
The outcome of treatment for gastrointestinal bleeding greatly depends on the cause and location of the
bleeding, the rate of bleeding when you see a doctor, and your age and prior health.