Dr. MJ Bazos MD,
the Digestive Tract
Bleeding 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 is important.
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 the stool.
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
- Shortness of breath
- Crampy abdominal pain
What Are the Symptoms of
- Shortness of breath
What Causes Bleeding
in the Digestive Tract?
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.
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
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.
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
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?
- Inflammation (esophagitis)
- Enlarged veins (varices)
- Mallory-Weiss syndrome
- Inflammation (gastritis)
Large Intestine and
- Inflammation (ulcerative colitis)
- Colorectal polyps
- Colorectal cancer
- Diverticular disease
How Is Bleeding in the
Digestive Tract Recognized?
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 Is Bleeding in the Digestive
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 as well.
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 with endoscopy.
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.
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 and cumbersome.
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 banding or
various heat or electrical 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