Gastrointestinal Bleeding 

Gastrointestinal bleeding is among the most serious medical conditions seen in individuals of all ages. It occurs when blood loss happens anywhere along the digestive tract. It can be mild to severe, and it's crucial to understand its signs and symptoms to seek timely medical attention. 

This article explores effective ways to manage gastrointestinal bleeding, covering various aspects of this condition. We'll delve into the types of gastrointestinal GI bleeding, including upper and lower gastrointestinal bleeds, and discuss their causes and risk factors. 

What is Gastrointestinal Bleeding? 

Gastrointestinal (GI) bleeding is a symptom that occurs when blood loss takes place anywhere along the digestive tract, from the oesophagus (commonly called a food pipe) to the rectum. It is not a condition in itself but rather a sign of an underlying disease or issue. Gastrointestinal bleeding symptoms can vary based on the location and severity of the bleeding, making it essential to recognise the different manifestations of bleeding in the gastrointestinal tract. 

Types of Gastrointestinal Bleeding 

Gastrointestinal bleeding can be categorised into several types based on various factors. One primary classification divides GI bleeding into upper and lower types, with the anatomical landmark being the ligament of Treitz. 

• Upper GI bleeding originates above the ligament of Treitz, the suspensory ligament of the duodenum. It typically presents as haematemesis (vomiting of blood or coffee- ground-like material) or melena (black, tarry stools). 
• Lower GI bleeding, originating below the ligament, commonly manifests as haematochezia (passing of bright red blood via the rectum). 

Another classification system categorises GI bleeding based on its duration and visibility:

• Acute GI bleeding is sudden and can sometimes be severe, requiring immediate medical attention. 
• On the other hand, chronic GI bleeding involves slight bleeding that can last for an extended period or may come and go. 
• Occult bleeding is microscopic and not visible to the naked eye. It can be detected only through laboratory tests. 

Symptoms of Gastrointestinal Bleeding 

Gastrointestinal bleeding symptoms depend on the location and severity of the bleeding. Common signs include: 

• Black or tarry stools (melaena) 
• Bright red blood in vomit or stools 
• Abdominal cramps 
• Dizziness 
• Weakness 
• Fatigue 
• Sometimes, vomit may resemble coffee grounds, indicating partially digested blood. 
• Chronic gastrointestinal bleeding often results in anaemia, causing tiredness and shortness of breath that develop gradually over time. 
• Other bleeding in the gastrointestinal tract symptoms include paleness, weakness, and shortness of breath. 

Causes and Risk Factors of Gastrointestinal Bleeding 

Gastrointestinal bleeding can affect different parts of the digestive system, typically categorised into upper and lower GI bleeding. 

The following are some upper GI bleeding causes: 

• Peptic ulcers 
• Helicobacter pylori infection 
• overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Oesophagitis 
• Gastroesophageal reflux disease (GERD) 
• Gastritis 
• Oesophageal varices 
• Gastrointestinal stromal tumour (GIST) 
• Pancreatic tumour 
• Stomach tumour 
• Liver cancer 

The following are some lower GI bleeding causes: 

• Diverticulosis 
• Inflammatory bowel diseases (Crohn's disease & ulcerative colitis) 
• Colon polyps 
• Haemorrhoids and anal fissures 
• Rectal ulcers 
• Colorectal cancer 
• Anal tumour 

Risk factors for gastrointestinal bleeding include: 

• Chronic alcohol consumption 
• Certain medications (especially NSAIDs and anticoagulants) 
• A history of gastrointestinal surgery 
• Chronic vomiting 
• Liver damage 

Complications of Gastrointestinal Bleeding 

Gastrointestinal bleeding, if not managed promptly and effectively, can lead to severe complications, including: 

• One of the most serious consequences of gastrointestinal bleeding is shock, which occurs when there is insufficient blood flow to vital organs. This condition can cause dizziness, faintness, and difficulty urinating. 
• Respiratory distress is another potential complication, as severe blood loss can affect oxygen delivery to the lungs. 
• In some cases, gastrointestinal bleeding may lead to myocardial infarction, particularly in patients with pre-existing heart conditions. Infection is also a concern, especially in cases of prolonged bleeding or when invasive procedures are necessary for treatment. 
• Chronic gastrointestinal bleeding can result in anaemia, causing fatigue and shortness of breath that develop gradually over time. 

Diagnosis 

Doctors conduct a comprehensive assessment to diagnose gastrointestinal bleeding, starting with a thorough medical history and physical examination. 

• Medical History and Physical Examination: 

Doctors ask about your symptoms, like black or tarry stools (melena), bright red blood in stools (haematochezia), or vomiting blood (haematemesis). They will ask about recent medical history, medications, and dietary habits. Doctors will do a physical examination to evaluate signs of bleeding, such as pallor or abdominal tenderness. 

• Lab Tests: 
  • Blood investigations are often performed to check for signs of anaemia and assess the severity of blood loss. 
  • A stool test, such as a faecal occult blood test (FOBT), detects microscopic blood in the faeces. 
• Endoscopic Procedures: 

Upper endoscopy allows examination of the oesophagus, stomach, and duodenum, while colonoscopy helps inspect the large intestine and rectum. For harder-to-reach areas of the small intestine, balloon enteroscopy or capsule endoscopy may be employed. 

• Imaging Tests: 
  • CT scans provide detailed 3D views of the intestines 
  • Specialised GI X-rays using barium contrast to check for signs of a bleed or other conditions. 
  • In some cases, doctors may perform angiography to visualise blood vessels in the GI tract. 
  • In cases where the source of bleeding remains elusive, more invasive procedures such as laparoscopy or laparotomy may be considered to examine the abdominal cavity directly. 

Gastrointestinal Bleeding Treatment 

Treating gastrointestinal bleeding depends on its severity, location, and underlying cause. 

• Initial Management: 
  • Fluid Resuscitation: IV fluids to maintain blood volume and pressure 
  • Blood Transfusions: Red blood cell transfusions usually start when haemoglobin levels fall below seven g/dL. Platelet transfusions may be necessary for patients with low platelet counts. 
• Medications: 
  • Proton Pump Inhibitors: These are used to produce stomach acid and help heal ulcers. 
  • Vasoactive Medications: In cases of variceal bleeding 
  • Antibiotics: If it is infection-induced bleeding (e.g., from ulcers or certain types of gastritis) 
  • Endoscopic Procedures: During these procedures, healthcare providers can remove abnormal growths, inject medications to stop bleeding, or seal abnormal blood vessels using clips or bands. 

When to See a Doctor 

Recognising when to seek medical attention for gastrointestinal bleeding is crucial for preventing severe complications. It's essential to seek immediate medical care if certain signs and symptoms occur, such as: 

• Dizziness or faintness (syncope) 
• Difficulty urinating 
• A rapid pulse 
• Shock 

Prevention 

Preventing gastrointestinal bleeding involves addressing the underlying causes and adopting healthy lifestyle habits. 

• Limit taking nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin 
• Lifestyle modifications such as limiting alcohol & quitting tobacco can help protect the gastrointestinal lining from damage. 
• For individuals with existing gastrointestinal conditions, following the doctor's recommendations for treatment is essential. 
• Regular check-ups and screenings are also important, especially for those at higher risk. 

Conclusion 

Gastrointestinal bleeding is a serious gastro-related condition that can affect people of all ages. Prompt medical attention is key when dealing with gastrointestinal bleeding. By being aware of the indications and risk factors, individuals can take steps to prevent complications and seek timely treatment. Remember, while some cases of GI bleeding can be managed at home effectively, others may require emergency care. Staying informed and proactive about one's health is essential to effectively address this serious medical concern. 

FAQS 

1. Are the symptoms of acute bleeding different? 

Acute gastrointestinal bleeding symptoms often come on suddenly and can be severe. Individuals may experience dizziness, faintness, or difficulty urinating. A rapid pulse, which can cause anxiety or a fluttering sensation in the heart, is another potential indicator. 

2. What types of testing might I need? 

To diagnose gastrointestinal bleeding, doctors may order various investigations. These can include blood sample analysis to check for anaemia and assess the severity of blood loss. Stool investigations, such as a faecal occult blood test, may be used to detect microscopic blood in the faeces. Imaging tests like CT scans or specialised X-rays using barium contrast can provide detailed views of the intestines. 

3. How do you know if you have gastrointestinal bleeding? 

Gastrointestinal bleeding symptoms can vary and depend on the location and severity of the bleeding. Common signs include black or tarry stools, bright red blood in vomit or stools, and abdominal pain. Other symptoms may include fatigue, pale skin, weakness and shortness of breath. 

4. How to treat gastrointestinal bleeding at home? 

It's crucial to understand that there is no safe home care for heavy gastrointestinal bleeding. Any significant bleeding in the gastrointestinal tract requires immediate consultation with an expert. 

5. What is the most common cause of GI bleeding? 

Gastrointestinal bleeding can have various causes, depending on whether it occurs in the upper or lower GI tract. Common causes of upper GI bleeding include peptic ulcers, esophagitis, and gastritis. For lower GI bleeding, common causes include haemorrhoids, anal fissures, diverticulosis, and inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. 

6. What foods should you avoid after a GI bleed? 

After a gastrointestinal bleed, following a diet that promotes healing & reduces the risk of further irritation is essential. Generally, it's advisable to avoid spicy and acidic foods and foods that are hard to digest. 

7. Is GI bleeding painful? 

Gastrointestinal bleeding can be associated with pain, although the level of discomfort can vary. Some individuals may experience abdominal cramps or pain, while others might not have any pain at all. The presence and severity of pain often depend on the underlying cause of the bleeding. It's essential to remember that the absence of pain does not necessarily indicate that the bleeding is less serious.

Dr. Rajesh Singhri

CARE Medical Team