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Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract.
Bleeding may come from any site along the GI tract, but is often divided into:
- Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine.
- Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus.
Lower GI bleeding; GI bleeding; Upper GI bleeding
ConsiderationsThe amount of GI bleeding may be so small that it can only be detected on a lab test such as the fecal occult blood test. Other signs of GI bleeding include:
- Dark, tarry stools
- Larger amounts of blood passed from the rectum
- Small amounts of blood in the toilet bowl, on toilet paper, or in streaks on stool (feces)
- Vomiting blood
Massive bleeding from the GI tract can be dangerous. However, even very small amounts of bleeding that occur over a long period of time can lead to problems such as anemia or low blood counts.
Once a bleeding site is found, many therapies are available to stop the bleeding or treat the cause.
GI bleeding may be due to conditions that are not serious, including:
However, GI bleeding may also be a sign of more serious diseases and conditions, such as the following cancers of the GI tract:
- Cancer of the colon
- Cancer of the small intestine
- Cancer of the stomach
- Intestinal polyps (a pre-cancerous condition)
Other possible causes of GI bleeding include:
- Abnormal blood vessels in the lining of the intestines (also called angiodysplasias)
- Bleeding diverticulum, or diverticulosis
- Crohn's disease orulcerative colitis
- Esophageal varices
- Gastric (stomach) ulcer
- Intussusception (bowel telescoped on itself)
- Mallory-Weiss tear
- Meckel's diverticulum
- Radiation injury to the bowel
There are home stool tests for microscopic blood that may be recommended for people with anemia or for colon cancer screening.
When to Contact a Medical Professional
Call for an appointment with your doctor if:
What to Expect at Your Office Visit
GI bleeding is diagnosed by a doctor -- you may or may not be aware of its presence.
GI bleeding can be an emergency condition requiring immediate medical attention. Treatment may involve:
- Blood transfusions
- Fluids and medicines through a vein
- Esophagogastroduodenoscopy (EGD) - a thin tube with a camera on the end is passed through your mouth into your esophagus, stomach, and small intestine
- A tube is placed through your mouth into the stomach to drain the stomach contents (gastric lavage)
Once your condition is stable, you will have a physical examination, including a detailed abdominal examination.
You will also be asked questions about your symptoms, including:
- When did you first notice symptoms?
- Did you have black, tarry stools or red blood in the stools?
- Have you vomited blood?
- Did you vomit material that looks like coffee grounds?
- Do you have a history of peptic or duodenal ulcers?
- Have you ever had symptoms like this before?
- What other symptoms do you have?
Tests that may be done to find the source of the bleeding include:
- Abdominal CT scan
- Abdominal MRI scan
- Abdominal x-ray
- Bleeding scan (tagged red blood cell scan)
- Blood clotting tests
- Capsule endoscopy (camera pill that is swallowed to look at the small intestine)
- Complete blood count (CBC), clotting tests, platelet count, and other laboratory tests
Bjorkman D. GI hemorrhage and occult GI bleeding. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 137.
Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 19.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.