Gastrointestinal bleeding refers to any form of hemorrhage or blood loss that occurs in the gastrointestinal tract, the passage that extends all the way from the mouth to the anus.

The causes of this type of bleeding are numerous but a patient’s symptom history and a physical examination usually help to distinguish the main causes. Bleeding can range in severity form mild or almost undetectable through to acute and life-threatening.

The upper digestive tract includes the food pipe (esophagus), the stomach and upper part of the first portion of the small intestine (duodenum). The lower digestive tract comprises the majority of the small intestine, all of the large intestine, the rectum and the anus.

Causes

Some examples of conditions that cause bleeding in the upper gastrointestinal tract include peptic ulcer, esophageal varices, gastritis and cancer of the esophagus or stomach. Examples of causes in the lower digestive tract include diverticulitis, colitis, hemorrhoids and cancer of the large intestine, colon or rectum.

Symptoms

Some of the symptoms of upper gastrointestinal bleeding include:

• Blood in the vomit
• Coffee ground appearance of vomit
• Black, tarry stool
• Bright red blood in stool

Some of the symptoms of lower gastrointestinal bleeding include:

• Black, tarry stool
• Bright red blood in stool
• Severe bleeding may lead to anemia, weakness, abdominal pain and diarrhea

Diagnosis

Diagnosis is usually made after taking a detailed patient history and performing a physical and clinical examination. Diagnosis commonly involves an endoscopy procedure. For an upper gastrointestinal endoscopy, a tube with a camera and a light source at its tip (endoscope) is passed down the esophagus and used to look for the site and cause of the bleeding. One of the most common causes of this type of bleeding is peptic ulcer. The lower gastrointestinal tract is examined using colonoscopy, which uses similar principles but is performed using an endoscope that is inserted via the rectum.

Treatment

Treatment is initially focused on fluid resuscitation to replenish bodily fluids lost through bleeding in order to prevent hypovolemia or shock. Depending on the cause and site of the bleeding, various different treatment approaches are used. For example, bleeding caused by peptic ulcer may be controlled using proton pump inhibitors while colonoscopy with cauterization may be required to treat lower gastrointestinal bleeding.