Bleeding in the Digestive Tract
What Causes Bleeding
in the Digestive Tract?
How Is Bleeding in the Digestive
How Is Bleeding in the Digestive Tract Diagnosed?
How Is Bleeding in the Digestive Tract Treated?
in the digestive tract is a symptom of digestive problems rather than
a disease itself. Bleeding can occur as the result of a number of different
conditions, many of which are not life threatening. Most causes of bleeding
are related to conditions that can be cured or controlled, such as hemorrhoids.
The cause of bleeding may not be serious, but locating the source of bleeding
The digestive or gastrointestinal (GI) tract includes
the esophagus, stomach, small intestine, large intestine or colon, rectum,
and anus. Bleeding can come from one or more of these areas, that is,
from a small area such as an ulcer on the lining of the stomach or from
a large surface such as an inflammation of the colon. Bleeding can sometimes
occur without the person noticing it. This type of bleeding is called
occult or hidden. Fortunately, simple tests can detect occult blood in
Bleeding in the Digestive Tract?
Stomach acid can cause inflammation that may lead to bleeding at the lower
end of the esophagus. This condition is called esophagitis or inflammation
of the esophagus. Sometimes a muscle between the esophagus and stomach
fails to close properly and allows the return of food and stomach juices
into the esophagus, which can lead to esophagitis. In addition, enlarged
veins (varices) at the lower end of the esophagus may rupture and bleed
massively. Cirrhosis of the liver is the most common cause of esophageal
varices. Esophageal bleeding can be caused by Mallory-Weiss syndrome,
a tear in the lining of the esophagus. Mallory-Weiss syndrome usually
results from prolonged vomiting but may also be caused by increased pressure
in the abdomen from coughing, hiatal hernia, or childbirth.
The stomach is a frequent site of bleeding. Alcohol, aspirin,
aspirin-containing medicines, and various other medicines (particularly
those used for arthritis) can cause stomach ulcers or inflammation (gastritis).
The stomach is often the site of ulcer disease. Acute or chronic ulcers
may enlarge and erode through a blood vessel, causing bleeding. Also,
patients suffering from burns, shock, head injuries, or cancer, or those
who have undergone extensive surgery may develop stress ulcers. Bleeding
can occur from benign tumors or cancer of the stomach, although these
disorders usually do not cause massive bleeding.
The most common source of bleeding from the upper digestive
tract is ulcers in the duodenum (the upper small intestine). Researchers
now believe that these ulcers are caused by excess stomach acid and infection
with Helicobacter pylori bacteria.
In the lower digestive tract, the large intestine and
rectum are frequent sites of bleeding. Hemorrhoids are probably the most
common cause of visible blood in the digestive tract, especially blood
that appears bright red. Hemorrhoids are enlarged veins in the anal area
that can rupture and produce bright red blood, which can show up in the
toilet or on toilet paper. If red blood is seen, however, it is essential
to exclude other causes of bleeding since the anal area may also be the
site of cuts (fissures), inflammation, or tumors.
Benign growths or polyps of the colon are very common
and are thought to be forerunners of cancer. These growths can cause either
bright red blood or occult bleeding. Colorectal cancer is the second most
frequent of all cancers in the United States and usually causes bleeding
at some time.
Inflammation from various causes can produce extensive
bleeding from the colon. Different intestinal infections can cause inflammation
and bloody diarrhea. Ulcerative colitis can produce inflammation and extensive
surface bleeding from tiny ulcerations. Crohn's disease of the large intestine
can also produce spotty bleeding.
Diverticular disease caused by diverticula--outpouchings
of the colon wall--can result in massive bleeding. Finally, as one gets
older, abnormalities may develop in the blood vessels of the large intestine,
which may result in recurrent bleeding.
What Are the Common Causes
of Bleeding in the Digestive Tract?
Enlarged veins (varices)
Large Intestine and Rectum
Inflammation (ulcerative colitis)
Bleeding in the Digestive Tract Recognized?
The signs of bleeding in the digestive tract depend upon the site and
severity of bleeding. If blood is coming from the rectum or the lower
colon, bright red blood will coat or mix with the stool. The stool may
be mixed with darker blood if the bleeding is higher up in the colon or
at the far end of the small intestine. When there is bleeding in the esophagus,
stomach, or duodenum, the stool is usually black or tarry. Vomited material
may be bright red or have a coffee-grounds appearance when one is bleeding
from those sites. If bleeding is occult, the patient might not notice
any changes in stool color.
If sudden massive bleeding occurs, a person may feel
weak, dizzy, faint, short of breath, or have crampy abdominal pain or
diarrhea. Shock may occur, with a rapid pulse, drop in blood pressure,
and difficulty in producing urine. The patient may become very pale. If
bleeding is slow and occurs over a long period of time, a gradual onset
of fatigue, lethargy, shortness of breath, and pallor from the anemia
will result. Anemia is a condition in which the blood's iron-rich substance,
hemoglobin, is diminished.
How Do You Recognize Blood in the Stool and Vomit?
Bright red blood coating the stool
Dark blood mixed with the stool
Black or tarry stool
Bright red blood in vomit
Coffee-grounds appearance of vomit
What Are the Symptoms of Acute Bleeding?
Shortness of breath
Crampy abdominal pain
What Are the Symptoms of Chronic Bleeding?
Shortness of breath
Bleeding in the Digestive Tract Diagnosed?
The site of the bleeding must be located. A complete history and physical
examination are essential. Symptoms such as changes in bowel habits, stool
color (to black or red) and consistency, and the presence of pain or tenderness
may tell the doctor which area of the GI tract is affected. Because the
intake of iron or foods such as beets can give the stool the same appearance
as bleeding from the digestive tract, a doctor must test the stool for
blood before offering a diagnosis. A blood count will indicate whether
the patient is anemic and also will give an idea of the extent of the
bleeding and how chronic it may be.
Endoscopy is a common diagnostic technique that
allows direct viewing of the bleeding site. Because the endoscope can
detect lesions and confirm the presence or absence of bleeding, doctors
often choose this method to diagnose patients with acute bleeding. In
many cases, the doctor can use the endoscope to treat the cause of bleeding
The endoscope is a flexible instrument that can be inserted
through the mouth or rectum. The instrument allows the doctor to see into
the esophagus, stomach, duodenum (esophago-duodenoscopy), colon (colonoscopy),
and rectum (sigmoidoscopy); to collect small samples of tissue (biopsies);
to take photographs; and to stop the bleeding.
Small bowel endoscopy, or enteroscopy, is a new procedure
using a long endoscope. This endoscope may be introduced during surgery
to localize a source of bleeding in the small intestine.
Several other methods are available to locate the
source of bleeding. Barium x-rays, in general, are less accurate than
endoscopy in locating bleeding sites. Some drawbacks of barium x-rays
are that they may interfere with other diagnostic techniques if used for
detecting acute bleeding; they expose the patient to x-rays; and they
do not offer the capabilities of biopsy or treatment.
Angiography is a technique that uses dye to highlight
blood vessels. This procedure is most useful in situations when the patient
is acutely bleeding such that dye leaks out of the blood vessel and identifies
the site of bleeding. In selected situations, angiography allows injection
of medicine into arteries that may stop the bleeding.
Radionuclide scanning is a noninvasive screening technique
used for locating sites of acute bleeding, especially in the lower GI
tract. This technique involves injection of small amounts of radioactive
material. Then, a special camera produces pictures of organs, allowing
the doctor to detect a bleeding site.
In addition, barium x-rays, angiography, and radionuclide
scans can be used to locate sources of chronic occult bleeding. These
techniques are especially useful when the small intestine is suspected
as the site of bleeding since the small intestine may not be seen easily
Bleeding in the Digestive Tract Treated?
The use of endoscopy has grown and now allows doctors not only to see
bleeding sites but to directly apply therapy as well. A variety of endoscopic
therapies are useful to the patient for treating GI tract bleeding.
Active bleeding from the upper GI tract can often be controlled
by injecting chemicals directly into a bleeding site with a needle introduced
through the endoscope. A physician can also cauterize, or heat treat,
a bleeding site and surrounding tissue with a heater probe or electrocoagulation
device passed through the endoscope. Laser therapy, although effective,
is no longer used regularly by many physicians because it is expensive
Once bleeding is controlled, medicines are often prescribed
to prevent recurrence of bleeding. Medical treatment of ulcers to ensure
healing and maintenance therapy to prevent ulcer recurrence can also lessen
the chance of recurrent bleeding. Studies are now under way to see if
elimination of Helicobacter pylori affects the recurrence of ulcer bleeding.
Removal of polyps with an endoscope can control bleeding
from colon polyps. Removal of hemorrhoids by chemical treatment, ligation,
ultrasonic devices, electrical devices, or various heat and cold devices,
is effective in patients who suffer hemorrhoidal bleeding on a recurrent
basis. Endoscopic injection or cautery can be used to treat bleeding sites
throughout the lower intestinal tract.
Endoscopic techniques do not always control bleeding.
Sometimes angiography may be used. However, surgery is often needed to
control active, severe, or recurrent bleeding when endoscopy is not successful.