Gastrointestinal bleeding

Gastrointestinal bleeding
Other namesGastrointestinal hemorrhage, GI bleed
Positive fecal occult blood test.jpg
A positive fecal occult blood test
SpecialtyGastroenterology Edit this on Wikidata
SymptomsVomiting red blood, vomiting black blood, bloody stool, black stool, feeling tired[1]
ComplicationsIron-deficiency anemia, heart-related chest pain[1]
TypesUpper gastrointestinal bleeding, lower gastrointestinal bleeding[2]
CausesUpper: peptic ulcer disease, esophageal varices due to liver cirrhosis, cancer[3]
Lower: hemorrhoids, cancer, inflammatory bowel disease[2]
Diagnostic methodMedical history and physical examination, blood tests[1]
TreatmentIntravenous fluids, blood transfusions, endoscopy[4][5]
MedicationProton pump inhibitors, octreotide, antibiotics[5][6]
Prognosis~15% risk of death[1][7]
FrequencyUpper: 100 per 100,000 adults per year[8]
Lower: 25 per 100,000 per year[2]

Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum.[9] When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.[1] Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain.[1] Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out.[1][9] Sometimes in those with small amounts of bleeding no symptoms may be present.[1]

Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding.[2] Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others.[3] Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.[2] Diagnosis typically begins with a medical history and physical examination, along with blood tests.[1] Small amounts of bleeding may be detected by fecal occult blood test.[1] Endoscopy of the lower and upper gastrointestinal tract may locate the area of bleeding.[1] Medical imaging may be useful in cases that are not clear.[1]

Initial treatment focuses on resuscitation which may include intravenous fluids and blood transfusions.[4] Often blood transfusions are not recommended unless the hemoglobin is less than 70 or 80 g/L.[7][10] Treatment with proton pump inhibitors, octreotide, and antibiotics may be considered in certain cases.[5][6][11] If other measures are not effective, an esophageal balloon may be attempted in those with presumed esophageal varices.[2] Endoscopy of the esophagus, stomach, and duodenum or endoscopy of the large bowel are generally recommended within 24 hours and may allow treatment as well as diagnosis.[4]

An upper GI bleed is more common than lower GI bleed.[2] An upper GI bleed occurs in 50 to 150 per 100,000 adults per year.[8] A lower GI bleed is estimated to occur in 20 to 30 per 100,000 per year.[2] It results in about 300,000 hospital admissions a year in the United States.[1] Risk of death from a GI bleed is between 5% and 30%.[1][7] Risk of bleeding is more common in males and increases with age.[2]

Signs and symptoms

Gastrointestinal bleeding can range from small non-visible amounts, which are only detected by laboratory testing, to massive bleeding where bright red blood is passed and shock develops. With bleeding that is rapid there may be syncope.[12]

Blood that is digested may appear black rather than red, resulting in "coffee ground" vomit or tar colored stool called melena.[2]

Other signs and symptoms include feeling tired, dizziness, and pale skin color.[12]