Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is usually a symptom of a digestive system problem. Blood can be seen in feces or vomit, although it isn't necessarily visible, even if it causes the stool to seem dark or tarry. The severity of the bleeding (hemorrhage) can range from minor to severe and can be fatal. Any of these areas can experience GI hemorrhages, such as the food pipe, stomach, bowels, or anus. Upper GI bleeding occurs in the esophagus, stomach, or first section of the small intestine (duodenum). Lower GI hemorrhage refers to bleeding in the small bowel, rectum, or anus. Lower GI bleeds are less prevalent than upper gastrointestinal bleeds. Resuscitation is the first line of therapy involving intravenous fluids and blood products. Endoscopy of the food pipe, belly, or bowels is generally suggested within 24 hours and can help with both care and prognosis.

The upper and lower digestive systems can both be affected by gastrointestinal bleeding. There are several reasons for this:

Upper Gastrointestinal Bleeding

Peptic Ulcers: The most prevalent cause of upper GI bleeding is peptic ulcers. They are lesions that form on the gut wall and the upper region of the small bowel. Stomach acid destroys the stomach lining, either due to germs or the use of anti-inflammatory medicines, resulting in ulcers.

If you use blood thinners, you may be at greater risk. Peptic ulcers can also be caused by an infection with the H-Pylori bug.

Mallory-Weiss tears: Tears in the food pipe are known as Mallory-Weiss tears. They are a type of tear that can lead to bleeding. These are more common in people who consume a lot of alcohol.

Esophageal varices: These are the veins in the esophagus that are excessively expanded. This disorder is particularly common in people who have advanced liver illness.

Esophagitis: The most prevalent cause of esophageal inflammation is gastroesophageal reflux disease.

Gastritis and duodenitis: Gastritis refers to gut inflammation, whereas duodenitis refers to inflammation of the small bowel. Both are usually triggered by H. pylori infection, although they can also be induced by other causes like the usage of analgesics or wine.

Ingestion of a foreign object: Swallowing anything indigestible might result in upper GI tract rips and hemorrhages.

Lower Gastrointestinal Bleeding

Diverticular disease: Diverticular disease is a kind of disease that affects the bowels. This is characterized by the formation of tiny, inflated pockets in the digestive system (diverticulosis). Diverticulitis occurs when one or all of the pockets become inflamed and swollen.

Inflammatory bowel disease: Inflammatory bowel disease is of two types:

• Ulcerative colitis, which leads to inflammation and ulcers in the rectum and colon
• Crohn's disease, which causes inflammation of the overall digestive system lining.

Colon polyps and Tumors: Tumors of the esophagus, stomach, colon, or rectum, whether benign or malignant, can damage the lining of the gastrointestinal tract and may lead to bleeding. Polyps are usually harmless, but sometimes they need to be excised if there is a suspicion of cancer.

Hemorrhoids: Another major reason for GI bleeding is hemorrhoids. A swollen vein in the rectum or anus is known as hemorrhoid. Rectal bleeding can occur when these swollen veins break and leak. This problem may go away on its own with just a few interventions. If the bleeding appears to indicate other, more serious GI disorders, a doctor may recommend an endoscopy.

Anal fissures: These are tiny rips in the anus lining.

Proctitis: Gastrointestinal bleeding can be caused by inflammation of the rectum's wall.

Gastrointestinal bleeding from the upper GI tract affects 50 to 150 people per 100,000 every year. Lower gastrointestinal bleeding, which is believed to arise at an incidence of 20 to 30 per 100,000 yearly, is less prevalent. Blood loss is more prevalent in men and becomes more so as they get older.

Gastrointestinal bleeding may vary from minimal quantities that are only found through lab tests to major bleeding that result in the passage of vibrant red blood cells and the development of hypotension.

Gastrointestinal (GI) bleeding can cause a variety of symptoms such as:

• A sluggish or viscous stool
• Vomit with intense red blood.
• Abdominal cramping
• Blood combined with feces 
• Fatigue
• Breathing problems
• Vomit with a coffee color

It is very necessary to get medical help right away. Also, if anyone suffers from any one of the following symptoms, seek treatment immediately:

• Severe vertigo/blackouts
• Confusion
• Low blood pressure
• Racing of heart
• Having difficulty breathing
• Severe chest pain

Blood investigation: A CBC, a study to evaluate how quickly the blood clots, liver function tests, and a platelet count may all be required.

Stool sample examination: Examining the cause of the occult bleeding can be done by examining your feces. 

Gastric lavage: A tube is inserted through your nose and into your tummy to remove the contents of your belly. This might help you figure out what's causing the bleeding.

Endoscopy of the small bowel: This technique involves passing a long tube through your mouth with a tiny camera on the end to allow your doctor to look at the inner lining of your bowel.

Colonoscopy: This technique involves passing a thin tube into your colon with a small camera on the tip to allow your surgeon to inspect the bowels and rectum. Your surgeon may take a biopsy sample during this procedure for further examination.

Capsule Endoscopy: You ingest a vitamin-sized pill with a special camera inside during this process. The capsule takes several photographs as it goes down your digestive tract and sends them to a device attached to a belt encircling your waistline. With this procedure, the doctor will be able to see inside your small intestine.

Flexible sigmoidoscopy: A catheter with a light and lens is inserted to examine your rectum and the last portion of the large bowel, which is known as the sigmoid colon.

Angiography: A special dye is injected into an artery and is followed by several X-rays to search for and repair bleeding arteries and other problems.

Imaging tests: An abdominal CT scan could be utilized to locate the bleed's location.

GI bleeding frequently ceases by itself. When it doesn't, the therapy will be determined by the source of the bleeding. Medications or procedures to control bleeding can be provided in many situations. An upper endoscopy, for instance, might occasionally be used to manage a bleeding peptic ulcer or to excise polyps during an endoscopy.

If you have an upper GI bleed, you may be administered a proton pump inhibitor (PPI) as an IV medicine to reduce the production of acid. Your doctor will evaluate if you need to keep taking a PPI once the cause of the bleeding has been discovered.

The treatment choices for an upper gastrointestinal bleed are determined by a number of criteria, including the position, extent, and source of the bleeding.

The goal for those who go to the emergency room with serious bleeds is to stop any further bleeding. If the doctor can locate the source of the bleed using diagnostic testing such as an endoscopy or capsule endoscopy, they can employ one of these treatments, such as:

• Administrating medication to the bleeding wound as soon as possible.
• Ablation of the bleeding spot using a sensor or laser.
• Securing a clip around the vasculature to keep it closed.

Individuals experiencing GI bleeding ought to get medical advice from a surgeon.

Mallory-Weiss tears were associated with mortality rates ranging from 13% to 34% for gastritis and duodenitis, 38–41% for stomach ulcers and esophagitis, 52% for varices, and 95% for upper gastrointestinal cancers. In addition, bleeding that happened as inpatients had a greater mortality rate than bleeding that occurred during arrival to the hospital.

Upper gastrointestinal bleeding or rupture can lead to death in certain individuals. In research published before 1997, the death rate was believed to be 12%, but a thorough review of more current information is required. Better therapy is likely to result in a lower death rate.

• To help avoid a GI bleed, you should minimize your consumption of nonsteroidal anti-inflammatory medicines.
• If you've had peptic ulcers or gastritis, avoiding alcoholic beverages and smoking will help you avoid GI bleeding in the future. Smoking and alcohol can cause ulcers by increasing gastric acidity. If you have GERD, follow your doctor's treatment recommendations.
• You may waste iron as a result of the bleeding. As a response, it's critical to consume iron-rich meals. Red meat, seafood, chicken, and yolks are among them.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 06, 2023.

References

https://medlineplus.gov/gastrointestinalbleeding.html

https://www.annemergmed.com/article/S0196-0644(20)30494-7/fulltext