Gastrointestinal Bleeding

What is gastrointestinal bleeding?

Gastrointestinal (GI) bleeding is when there is bleeding in the GI tract, which includes the esophagus, stomach, small intestines, colon (large intestines), rectum, and anus. GI bleeding is typically grouped into two large categories: upper and lower GI bleeding. The upper GI tract includes the esophagus, stomach, and part of the small intestine; the lower GI tract includes the rest of the small intestine, colon, rectum, and anus.

The bleeding could be small, so it is not always visible in stool or vomit. GI bleeds may or may not be serious, depending on the amount of blood lost and the condition causing the bleed. However, over time, small, continuous bleeds can lead to a significant amount of blood loss.

Risk Factors and Causes

Risk factors that may lead to GI bleeding include:

• Chronic vomiting
• Alcoholism
• Medications, including but not limited to
  • Non-steroidal anti-inflammatories (NSAIDs); commonly used NSAIDs include
    • Aspirin
    • Ibuprofen (Advil)
    • Naproxen (Aleve)
  • Anticoagulants
• Gastrointestinal surgery

Causes of minor bleeds are:

• Hemorrhoids
• Anal fissures or tears

Causes of more serious bleeds include:

• Ulcers
• Cancer (anywhere along GI tract)
• Polyps
• Inflammation in the GI tract (i.e. esophagitis, gastritis, colitis)
• Variceal bleeding, typically caused by liver damage
• Inflammatory bowel disease
  • Crohn’s disease
  • Ulcerative colitis
• Angiodysplasia
• Diverticulosis
• Meckel’s diverticulum
• Mallory-Weiss tears (tears in esophagus or upper stomach)
• Trauma

Symptoms

Symptoms will differ based on the location and cause of the GI bleed, and microscopic GI bleeds can only be detected with lab tests. Visible symptoms include

• Blood on toilet paper
• Red, bloody stools
• Black or tarry stools
• Red, bloody vomit
• Vomit that looks like coffee grounds

Other symptoms may include

• Weight loss
• Abdominal cramps
• Dehydration
• Fever
• Anemia
• Low blood pressure
• Fainting

Depending on the cause of the GI bleed, there may be other symptoms as well (i.e. jaundice or yellowing skin for liver damage).

Diagnosis

The following tests may be performed to determine the source of bleeding and the underlying cause:

• Endoscopy (procedure involving a camera to look at the inside of the GI tract); a subtype is colonoscopy
• Angiography (X-ray with contrast agent to visualize blood vessels)
• Ultrasound
• CT scan
• MRI
• Complete blood count
• Hemoglobin levels
• Electrolyte levels
• Coagulation (blood clotting) tests

Treatments

There are multiple approaches for treating GI bleeding.  An interventionalist begins by gaining arterial access in the groin through the femoral artery and will then navigate to  the area of concern using x-ray guidance and a series of wires and tubes. At this point different approaches can be used to stop the bleeding.  Small particles or wire coils can be placed in the artery to occlude the artery.  Another option is to administer medications that cause the arteries to constrict directly into the bleeding vessel in an attempt to stop the bleeding.  Occasionally a stent will be placed to wall of the site of bleeding. See our embolization page and stent graft placement page for more information.

For More Information:

For more information or to schedule an appointment with one of our IR physicians, please call 310-481-7545.