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Gastrointestinal (GI) bleeding is bleeding in the digestive tract. It can be deadly.
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The upper digestive tract is the:
- Esophagus—the tube that moves food from the mouth to the stomach
- Upper part of the small intestine
The lower digestive tract is the:
- Lower part of the small intestine
- Large intestine
- Rectum and anus
GI bleeding has many causes.
Causes in the upper digestive tract:
- Peptic ulcer—a sore in the lining of the stomach or part of the small intestine
- Esophageal varices—swollen veins in the esophageal lining
- Mallory-Weiss tears—tears in the esophageal lining
- Gastritis—inflammation and sores in the stomach lining
- Esophagitis—inflammation and sores in the esophageal lining
- Benign tumors—noncancerous growths
- Stomach arteriovenous malformations
- Cancer in the esophagus, stomach, or small intestine
Causes in the lower digestive tract:
- Angiodysplasia—a growth of blood vessels in the intestine
- Diverticulum—a pouch that forms on the wall of the large intestine
- Diverticulitis—happens when the pouch becomes inflamed
- Inflammatory bowel diseases
- Hemorrhoids—enlarged veins in the rectum or anus
- Fissures—tears in the anus
- Polyps, or cancer in the colon, rectum, or anus
Things that may raise the risk of this problem are:
Upper and lower digestive tract bleeding may cause:
- Black, tarry stool
- Blood in the stool
Upper digestive tract bleeding may also cause:
- Blood in vomit
- Vomit that looks like coffee grounds
Sometimes, bleeding can happen quickly and be severe. This may cause:
- Light-headedness or faintness
- Breathing problems
- Belly pain
- Pale skin
Bleeding may be light and happen for a long time. This may cause a person to be tired and have problems breathing.
The doctor will ask about your symptoms and health history.
Tests that may be done are:
- Blood tests
- Breath test
- Stool test to check for blood
- Upper GI endoscopy—a thin, lighted tube is placed in the mouth and moved into the stomach and upper part of the small intestine
- Colonoscopy—a thin, lighted tube is placed in the anus and moved into the rectum and large intestine
- CT scan
- A nasogastric tube placed through the nose and into the stomach
- Barium x-ray—contrast material is swallowed or used as an enema to see structures
- Radionuclide scanning—to see how blood flows through the GI tract
- Angiography—to see the blood vessels
Treatment depends on what is causing the bleeding. Some choices are:
Medicines may need to be stopped or changed. Depending on the cause, one or more other medicines may be used to:
- Lower the amount of acid the stomach makes
- Treat bacterial infections
- Lessen bleeding
- Lessen inflammation
- Place healthy bacteria into the GI tract
Endoscopy can also be used to stop bleeding by:
- Injecting chemicals into the bleeding site
- Using a heat probe, electric current, or laser to seal off the bleeding site
- Using a band or clip to close off blood vessels
Angiography can also be used to control bleeding. Other tools are used to find the bleeding. Medicines or other materials are injected into the blood vessels to control it.
Surgery may be used when other methods fail. It may be needed to treat problems, such as uncontrolled bleeding.
To lower the risk of GI bleeding:
- Limit alcohol use.
- Use NSAIDs as advised.
- Do not smoke.
American College of Gastroenterology
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Association of Gastroenterology
Canadian Digestive Health Foundation
Acute lower gastrointestinal bleeding in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-lower-gastrointestinal-bleeding-in-adults. Accessed October 23, 2020.
Acute nonvariceal upper gastrointestinal bleeding. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/acute-nonvariceal-upper-gastrointestinal-bleeding. Accessed October 23, 2020.
Barkun AN, Almadi M, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019 Oct 22 early online, and previous version can be found in Ann Intern Med 2010 Jan 19;152(2):101.
Gastrointestinal (GI) bleeding. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding. Accessed October 23, 2020.
Overview of gastrointestinal bleeding. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastrointestinal-bleeding/overview-of-gastrointestinal-bleeding. Accessed October 23, 2020.
- Reviewer: EBSCO Medical Review Board Daniel A. Ostrovsky, MD
- Review Date: 09/2020
- Update Date: 05/18/2021