Gastrointestinal bleeding

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The gastrointestinal tract is the course through which food and liquid run through the body. It includes the mouth, esophagus, stomach, liver, gallbladder, small intestine, large intestine (colon), rectum, and anus. If bleeding occurs in this digestive tract, it is commonly referred to as gastrointestinal (GI) bleeding.

GI bleeding is not a disease, but rather a symptom of an underlying condition ranging from gastroesophageal reflux disease (GERD) to hemorrhoids to colon cancer. There are two types of GI bleeding:

  • Acute GI bleeding – This bleeding comes suddenly and can sometimes be severe.
  • Chronic GI bleeding – This is marked by slight bleeding that can last a long time. It may come and go.

Nearly 100,000 people visit U.S. hospitals annually due to GI bleeding, with higher occurrences among men than women.

Signs of GI bleeding can vary depending on the location of the source. Bleeding in the stomach may result in blackish stools, while bleeding in the colon can produce bright red blood in the stool. General symptoms include:

  • Black or tar-like stools
  • Dark or bright red blood in the stool
  • Bright red blood in vomit
  • Coffee ground-like vomit
  • Fatigue and weakness
  • Dizziness or faintness
  • Anemia (chronic GI bleeding)

If you are having acute or chronic signs of gastrointestinal bleeding, you should contact your gastroenterologist as this is not considered normal. If you have significant bleeding that is causing symptoms such as dizziness, low blood pressure, or fatigue, you may be required to go to the emergency room.

Your gastroenterologist will want to determine the location of the bleeding and the risk you are having from your bleeding. Oftentimes, you will need a procedure to control and stop the bleed.

  • Endoscopy – The gastroenterologist feeds a flexible tube (endoscope) with a camera into the GI tract to examine the location of the bleeding. In an upper endoscopy, the tube is fed into the esophagus, then through to the stomach and to the duodenum (opening of the small intestine).
  • Capsule endoscopy – The patient takes a capsule containing a tiny camera, providing a feed the gastroenterologist can track as it passes through the GI tract.
  • Colonoscopy – A long, flexible tube equipped with a tiny video camera (colonoscope) is inserted into the colon through the anus. The doctor examines the entire colon.
  • Sigmoidoscopy – This procedure is similar to a colonoscopy but examines just the last two feet of the colon.
  • Enteroscopy –A special endoscope is used to examine the small intestine.
  • Imaging – A number of X-rays can help the gastroenterologist locate the source of bleeding. The patient will likely be administered a dye or barium-containing fluid to outline the tract.

Most cases, even if severe, can be treated by a gastroenterologist. Procedures include:

  • Injecting medications – Using the scope as a guide, the doctor can inject medications into the site of the bleeding.
  • Cauterizing the source – The doctor applies a heat probe, laser, or electric current to stop and heal the source of the bleeding and surrounding tissue.
  • Clip the site – A clip or band is placed on the bleeding blood vessel and closes it off.

Other treatments:

  • Medications – If the bleeding is caused by ulcers or infections, some additional medications may be prescribed.
  • Laparoscopic surgery – In severe cases of acute GI bleeding, a surgeon may need to make small incisions to access the affected area and treat the bleeding using use an instrument with an attached camera and tools.

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