Gastrointestinal Bleeding
Gastrointestinal injury, ulcers and related bleeding are serious health matters that often strike patients by surprise, including those with or without any past symptoms or underlying digestive condition. The two primary causes of ulcers are damage from 1) the presence of a microorganism known as Helicobacter pylori; or 2) from regular use of non-steroidal anti-inflammatory drugs (known as NSAIDS), including aspirin. While some damage may occur with modest, short-term doses, problems are more likely to arise in regular NSAID users, and increase with the magnitude of use—more frequent use and/or higher dosages. NSAIDs and aspirin have some very positive health benefits. Like all medications, care must be taken with their use. They should not be taken with alcohol, as the combination can increase the risk of GI bleeding
Patients who need to use NSAIDs regularly should consult with their physician on a regular basis to be alert for any potential GI effects. Problems may arise with few, if any, symptoms, but if they are recognized early, there are a variety of ways to minimize or reverse any adverse effects. Options include using alternatives to NSAIDs, or your physician prescribing medications that can reduce any adverse effects.
The Gastrointestinal Tract
The gastrointestinal (GI) tract permits food to be made into nutrients that provide energy, and then allows the unused matter to be removed from the body. The GI tract starts with the mouth, where food is eaten, and follows to the esophagus, the stomach, the small intestine, the large intestine (colon) and the rectum. Other organs associated with the GI system include the liver, pancreas and gallbladder; these produce various substances that flow into the intestine to aid digestion.
GI Bleeding: What It Is and What It Is Not
When your physician speaks about GI bleeding, he/she is usually not talking about an external wound that results in visible bleeding from one or more GI organs, but rather means something more specific. Bleeding in the gastrointestinal tract means that some part of the body represented in the diagram on page 1 is bleeding internally, either slightly (which may or may not be very serious) or heavily (which may have serious health consequences.) In many cases such bleeding arises from ulcers, which are injuries or damage to the intestinal lining that may result in GI bleeding.
Patients Can Have GI Bleeding without any Obvious Symptoms
An individual can develop damage to the intestinal lining without being aware of it—significant GI bleeding occurs frequently without any symptoms being present.
How Do You Recognize the Symptoms of GI Bleeding?
Because GI bleeding is internal, it is possible for a person to have GI bleeding without having pain, literally without knowing you are bleeding. That is why it is important to recognize those symptoms that may accompany GI bleeding. The symptoms of possible GI bleeding vary, depending upon whether the source of the bleeding is in the upper part of the digestive tract (the esophagus, stomach or the beginning of the small intestine) or in the lower part (small intestine, colon or rectum).
Symptoms of Upper GI Bleeding:
- vomiting bright red blood
- vomiting dark clots, or material that looks like coffee grounds
- passing black, tar-like stool
- blood in the stool
- tiredness, shortness of breath due to iron deficiency anemia
Symptoms of Lower GI Bleeding:
- passing pure blood or blood mixed in stool
- bright red or maroon colored blood in the stool
- tiredness, shortness of breath due to iron deficiency anemia
What are the Different Types of GI Bleeding?
GI bleeding may come from various parts of the GI tract, and may be caused by various things:
| PLACE | TYPE OF BLEEDING | POSSIBLE REASON(S) |
| Esophagus | Vomiting bright red (blood) or coffee grounds material Black Stools | Ulcer varices* Tear (forceful retching) Liver Disease Chronic Hepatitis |
| Stomach | Vomiting bright red (blood) or material that looks like coffee grounds Black Stools | Ulcer, Swollen blood vessels in the stomach (known as varices) |
| Small Intestine | Bright red/maroon bleeding in stool | Ulcer, AVMs** |
| Large Intestine (Colon) | Blood in Stool
| Colon Cancer, Polyps, Colitis, AVMs |
| Rectum | Bright red bleeding | Hemorrhoids Tumor |
*Varices = Esophageal varices are dilated blood vessels within the wall of the esophagus ** AVMs = Arteriovenous malformations are abnormally dilated intraluminal blood vessels that often present as gastrointestinal bleeding.
What can You Do if You are Concerned about Avoiding GI Bleeding?
If you are taking over-the-counter NSAIDs on a regular basis, you will want to talk with your physician about the potential for ulcers and other GI side effects. Most patients contact their family doctor, or primary care physician, when they experience GI problems. Many of these disorders, including Helicobacter pylori, can be treated readily by your primary care doctor.
In the case of recurring or more serious problems, you may need to see a gastroenterologist, a physician who specializes in disorders and conditions of the gastrointestinal tract. After completing the same training as all other physicians, gastroenterologists study for an additional two to three years to train specifically in conditions of the gastrointestinal tract.
IMPORTANT REMINDER:
The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.