Gastrointestinal (GI) Bleeding

What is a GI bleed?

Gastrointestinal bleeding is when there is blood loss from any of the several organs included in your digestive system. It can occur from any part of the GI tract that runs from your mouth to your anus.

Upper GI bleeds stem from issues with your:

• Esophagus.
• Stomach.
• Duodenum (first part of your small intestine).

Small Bowel bleeds stem from issues with your:

• Jejunum (middle part of your small intestine).
• Ileum (the last section of your small intestine).

Lower GI bleeds stem from issues with your:

• Colon.
• Rectum.
• Anus.

What are the types of GI bleeds?

• Acute: Sudden, severe bleeding that’s a sign of a medical emergency.
• Chronic: Bleeding that comes and goes over a long time.
• Occult: Bleeding is not visible as it is microscopic, but you can see signs of GI blood loss (such as low blood counts) on laboratory testing.
• Overt: Visible signs of a GI bleed, including abnormal colors or substances in your feces (poop). You may also vomit blood.
• Obscure: When standard endoscopy testing does not reveal a source of GI bleeding.

What causes an upper GI bleed?

Issues affecting the upper GI area that can cause bleeding include:

• Crohn's disease.
• Esophageal cancer.
• Esophageal varices.
• Esophagitis.
• Gastritis.
• Gastrointestinal stromal tumor (GIST).
• GERD (Chronic Acid Reflux).
• Liver cancer.
• Pancreatic cancer.
• Peptic ulcers.
• Stomach cancer.

What causes a lower GI bleed?

Issues affecting the lower GI area that can cause bleeding include:

• Anal cancer.
• Anal fissures.
• Colon polyps.
• Colorectal cancer.
• Crohn's disease.
• Diverticulitis and diverticulosis.
• Gastrointestinal stromal tumor (GIST).
• Hemorrhoids.
• Rectal ulcers.
• Ulcerative colitis.

What are the symptoms of a GI bleed?

GI bleed symptoms depend on the source and how severe it is.

You may experience:

• Abdominal cramping.
• Dark-colored poop or regular-colored poop with blood in it.
• Pale appearance.
• Shortness of breath (dyspnea).
• Tiredness
• Vomit with blood in it or a substance that looks like coffee grounds.
• Weakness and fatigue.

Are the symptoms of acute bleeding different?

Acute GI bleed symptoms come on suddenly and are often severe. It’s important to seek immediate medical care if you notice:

• Dizziness or faintness (syncope).
• Difficulty urinating.
• Rapid pulse, which can make you feel anxious or like your heart is fluttering.
• Shock, which occurs when there isn’t enough blood flow to your organs.

How is GI bleeding diagnosed?

Healthcare providers perform a thorough assessment that starts with you describing your symptoms. To identify the source of the bleed and how severe it is, you will need to undergo testing.

What types of testing might I need?

Initial steps may include:

• Blood tests check for signs of GI bleeds, such as anemia, using a sample of your blood.
• Fecal occult blood test (FOBT) is a lab test that checks for signs of blood in a poop sample.
• CT scan is a sophisticated imaging study that uses technology to produce 3D, enhanced views of your intestines.
• GI X-rays take images of your upper or lower digestive tract to check for signs of a bleed or other conditions. The tests use a barium contrast solution that makes it easier to see the digestive tract on the X-ray.
• Upper endoscopy is a procedure to examine symptoms of an upper GI bleed. It uses a long tube with a camera and light at the tip (endoscope).
• Balloon enteroscopyis like an endoscopy. It uses long tubes and a camera. Tiny balloons at the endoscope tip inflate to help providers examine hard-to-reach small bowel.
• Colonoscopy or sigmoidoscopy is a procedure to examine signs of a lower GI bleed. The test uses endoscopes that are passed through the anus.

Are there other tests I may need?

More tests may be necessary if:

• Your healthcare provider cannot pinpoint the source of the bleed.
• You’re showing signs of an acute bleed.

These tests may include:

• Angiography is an imaging study that uses dye to make the GI tract’s blood vessels easier to see.
• Capsule endoscopy involves swallowing a pill-sized camera. As it travels along the GI tract, it takes pictures. You eliminate the camera through a bowel movement.
• Radionuclide scan involves receiving a substance with safe levels of radioactive material. The substance highlights red blood cells during an imaging study.

What medical therapies are available for GI bleeds?

Medications can treat some bleeds, including ones due to ulcers, hemorrhoids or GERD. These medications:

• Reduce levels of stomach acid.
• Help your blood clot.
• Relieve swelling.

Will I need a procedure?

In many cases, healthcare providers deliver GI bleed treatments during an endoscopy or colonoscopy. Tiny instruments at the tip of the endoscope or colonoscope make it possible to:

• Remove abnormal growths, such as colon polyps.
• Inject medications that help the body stop bleeding.
• Seal abnormal blood vessels with a tiny clip or band.
• Use low levels of a laser or a hot or cold gas to destroy the tissue causing the bleed.

How is GI bleed treatment different when the bleeding is acute?

For severe bleeds, emergency surgery may be necessary. Care may include laparoscopy. Surgeons make tiny incisions through which they pass a tiny camera and surgical instruments. This technique enables them to quickly access the source of the bleed and deliver treatment.

How can I prevent GI bleeding?

Steps you can take to protect yourself against GI bleeding include:

• Taking nonsteroidal anti-inflammatory medicines (NSAIDs) and aspirin only when necessary.
• Limiting alcohol use.
• Quitting tobacco if you regularly use it.
• Getting treatment to keep symptoms of GI conditions, like diverticulitis, well managed.
• Checking for infections like helicobacter pylori, if one is at risk, which can cause ulcers.

What is the outlook for people who have had a GI bleed?

Most people make a full recovery. It can take your intestines a few months to heal. You can lower the risk of future bleeds by making lifestyle changes, such as:

• Avoiding medications that can provoke bleeding if possible.
• Treating causes of ulcers, like helicobacter pylori infections.
• Reducing stress, which may involve relaxation techniques, like deep breathing.
• Maintaining an active lifestyle and balanced diet, so you achieve a healthy weight.

Will I need to follow special care instructions?

Even if treatment is successful, GI bleeds can come back. Other actions you can take to protect your health include:

• Going to all follow-up appointments. These visits enable your healthcare provider to assess treatment progress. Testing can detect the early signs of new bleeds.
• Staying on medications. If medication side effects make you sick, talk with your healthcare provider. They may reduce the dose or prescribe a gentler option.
• Maintaining lifestyle changes. Even if you no longer have GI bleed symptoms, a healthy lifestyle can help you continue feeling your best.

A note from Cleveland Clinic

GI bleeding is a symptom of many medical issues and can occur anywhere along the digestive tract. Healthcare providers often use endoscopy or colonoscopy to diagnose and treat bleeds. Bleeds can come back even after successful treatment. This is why it’s important to follow care instructions, even if you’re not experiencing symptoms.