Bleeding in 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.
What Causes 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?
Esophagus
- Inflammation (esophagitis)
- Enlarged veins (varices)
- Mallory-Weiss syndrome
Stomach
- Ulcers
- Inflammation (gastritis)
Small Intestine
Large Intestine and Rectum
- Hemorrhoids
- Inflammation (ulcerative colitis)
- Colorectal polyps
- Colorectal cancer
- Diverticular disease
How Is 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 Is 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
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.
Other Procedures
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.
How Is 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 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 successful.
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?
- Weakness
- Shortness of breath
- Dizziness
- Crampy abdominal pain
- Faintness
- Diarrhea
What Are the Symptoms of Chronic Bleeding?
- Fatigue
- Shortness of breath
- Lethargy
- Pallor
Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, December 1992
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