Patient education: GI bleed (The Basics)

What is a GI bleed? — "GI" stands for "gastrointestinal." The GI system, or GI tract, includes all of the organs in the body that process food (figure 1). This includes the:

●Esophagus (the tube that connects the mouth to the stomach)

●Stomach

●Small intestine (small bowel)

●Large intestine (colon or large bowel)

A GI bleed is when any of these organs start to bleed. Often, you do not know that you are bleeding, because it's happening inside your body. But sometimes, there are signs that it is happening.

There are 2 common types of GI bleeds:

●"Upper GI bleeds" – These affect the esophagus, the stomach, and the first part of the small intestine.

●"Lower GI bleeds" – These affect the large intestine (colon).

Bleeding can also happen in the middle of the small intestine, but this is much less common. This is sometimes called "mid-GI bleeding."

What are the symptoms of a GI bleed? — The symptoms depend on whether you have an upper or lower GI bleed. Some people have no symptoms. They find out that they have bleeding when a doctor or nurse does a rectal exam on them or a blood test shows that they have something called "anemia." (Anemia is when a person has too few red blood cells.)

The symptoms of an upper GI bleed can include:

●Vomiting blood or something that looks like coffee grounds

●Diarrhea or bowel movements that look like black tar – This can happen with lower GI bleeds, too, but it is less common.

The symptoms of a lower GI bleed can include:

●Bowel movements that look bloody – This can happen with upper GI bleeds, too, but it is less common.

Symptoms that can happen with either an upper or lower GI bleed include:

●Feeling weak, lightheaded, or woozy (especially if you lose a lot of blood)

●Racing heartbeat (if you lose a lot of blood)

●Cramps or belly pain

●Diarrhea

●Pale skin

Should I see a doctor or nurse? — See your doctor or nurse right away if you:

●Vomit blood or something that looks like coffee grounds

●Have a bowel movement that looks like tar or has blood in it

●Feel weak, lightheaded, or woozy

●Have a racing heartbeat

●Have severe belly pain

●Turn much paler than normal

What can cause a GI bleed? — The most common causes of GI bleeds include:

●Ulcers in the stomach or small intestine – Ulcers are sores on the lining of the GI tract.

●Problems with the blood vessels, for example:

•Swollen veins in the esophagus called "varices"

•Abnormal blood vessels called "arteriovenous malformations" ("AVMs")

•Fragile, swollen blood vessels called "gastric antral vascular ectasia" ("GAVE")

●Diverticulosis – This is a condition in which tiny pouches form in the lining of the intestine.

●Crohn disease or ulcerative colitis – These are conditions that can cause sores to form in the lining of the gut.

●Hemorrhoids – These are swollen veins in the rectum (the lower part of the colon).

●Anal fissures – These are tears around the anus.

●Polyps – These are small growths that can form inside the colon.

●Cancer (this is rare)

Is there a test for a GI bleed? — Yes. If your doctor or nurse suspects that you have a GI bleed, they will order 1 or more tests. Tests include:

●Blood tests to check if:

•You have enough red blood cells (the cells that carry oxygen)

•Your blood is clotting normally

•Your liver is working normally

●Upper endoscopy – For this test, you will get medicine to make you sleepy and relaxed. Then, a doctor puts a thin tube called an "endoscope" in your mouth and down your throat. The tube has a light on the end and a camera that sends images of your GI tract to a TV screen. If the doctor sees any spots that are bleeding, they can use tools that go through the endoscope to help stop the bleeding.

●Colonoscopy – This test is similar to an upper endoscopy, but lets the doctor look inside the colon. The tube goes in through the anus (figure 2).

●Imaging tests that involve putting a dye or weakly radioactive chemical into the blood – These allow doctors to trace where the blood goes.

●Capsule endoscopy – This test uses a small camera about the size of a vitamin pill. You swallow the camera, and it sends pictures to a recording device that you wear on a belt for 8 hours. A doctor then looks at the pictures. This test lets doctors look at the small intestine, which is hard to see with upper endoscopy or colonoscopy because it is very long. After the test, the camera passes with a bowel movement. Most people do not notice when it comes out.

How is a GI bleed treated? — Treatment depends on how much blood you have lost and what seems to be causing your bleeding. You might get 1 or more of these treatments:

●Oxygen – This can be given through a mask or a tube that sits under your nose.

●Blood or fluids given by IV – An IV is a thin tube that goes into a vein. This might be done to replace blood that you lost or treat a bleeding disorder.

●Medicines to reduce stomach acid or treat a bleeding disorder

●Medicines to help clean out and empty your GI system – This lets the doctor see more clearly what is happening inside.

●Antibiotics

●A small tube that goes up your nose and down your throat – This is a way for the doctor to rinse out your stomach.

Depending on where the bleeding seems to be, you might also have an upper endoscopy, a colonoscopy, or both. This can help the doctors find where the bleeding is coming from. Doctors can sometimes use the endoscope or colonoscope to seal off blood vessels and stop them from bleeding.

After the bleeding has stopped, your doctor or nurse will probably want to learn why you started bleeding in the first place. If you have ulcers or another condition that could lead to bleeding, they will want to make sure that those problems are treated.

Can a GI bleed be prevented? — To help lower your chances of getting a GI bleed:

●Do not take medicines called "NSAIDs" too often, unless your doctor tells you that it is OK – These medicines can cause ulcers. Examples of NSAIDs include aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand names: Aleve, Naprosyn). If you have to take these medicines regularly, your doctor might give you another medicine to decrease your risk of bleeding.

●Get treated for stomach ulcers, if you have them.

●Get treatment for esophageal varices, if you have them – These are swollen blood vessels in the esophagus. They are common in people with a liver disease called "cirrhosis." Getting treatment with medicines or a procedure can lower the risk of bleeding.

More on this topic

Patient education: Bloody stools in adults (The Basics)
Patient education: Bloody stools in children (The Basics)
Patient education: Peptic ulcers (The Basics)
Patient education: Upper endoscopy (The Basics)
Patient education: Colonoscopy (The Basics)
Patient education: Angiodysplasia of the GI tract (The Basics)
Patient education: Esophageal varices (The Basics)

Patient education: Blood in bowel movements (rectal bleeding) in babies and children (Beyond the Basics)
Patient education: Blood in the stool (rectal bleeding) in adults (Beyond the Basics)
Patient education: Peptic ulcer disease (Beyond the Basics)
Patient education: Upper endoscopy (Beyond the Basics)
Patient education: Colonoscopy (Beyond the Basics)