Bleeding in the digestive tract is a symptom of a disease rather than a disease itself. Bleeding can occur as the result of number of different conditions, some of which are life-threatening. Most causes of bleeding are related to conditions that can be cured or controlled, such as ulcers or haemorrhoids. The cause of bleeding may not be serious, but locating the source of bleeding is important.
The digestive or gastrointestinal (GI) tract includes the oesophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from one or more of these areas, that is, from a small area such as an ulcer on the lining of the stomach or from a large surface such as an inflammation of the colon. Bleeding can sometimes occur without the person noticing it. This type of bleeding is called occult or hidden. Fortunately, simple tests can detect occult blood in the stool.
Causes of bleeding in the digestive tract
Stomach acid can cause inflammation that may lead to bleeding at the lower end of the oesophagus. This condition, usually associated with the symptom of heartburn
, is called inflammation of the oesophagus.
can be caused by a tear in the lining of the esophagus. The condition usually results from vomiting but may also be caused by increased pressure in the abdomen from coughing, hiatal hernia, or childbirth. Oesophageal cancer can cause bleeding.
The stomach is a frequent site of bleeding. Infections with Helicobacter pylori, alcohol, aspirin, aspirin-containing medicines, and various other medicines can cause stomach ulcers
or inflammation. The stomach is often the site of ulcer disease. Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding. Bleeding can also occur from benign tumours or cancer of the stomach
, although these disorders usually do not cause massive bleeding.
A common source of bleeding from the upper digestive tract
is ulcers in the duodenum (the upper small intestine). Duodenal ulcers are most commonly caused by infection with H. pylori bacteria
or drugs such as aspirin
In the lower digestive tract, the large intestine and rectum are frequent sites of bleeding. Haemorrhoids
are the most common cause of visible blood in the digestive tract
, especially blood that appears bright red.
Inflammation from various causes can produce extensive bleeding from the colon. Different intestinal infections can cause inflammation and bloody diarrhoea. Ulcerative colitis
can produce inflammation and extensive surface bleeding from tiny ulcerations. Crohn’s disease
of the large intestine can also produce bleeding.
Diagnosis of bleeding in the digestive tract
The site of the bleeding must be located. A complete history and physical examination are essential. Symptoms such as changes in bowel habits, stool colour and consistency, and the presence of pain or tenderness may tell the gastroenterologist
which area of the GI tract is affected.
- Endoscopy: Endoscopy is a common diagnostic technique that allows direct viewing of the bleeding site. Because the endoscope can detect lesions and confirm the presence or absence of bleeding, doctors often choose this method to diagnose patients with acute bleeding. In many cases, the gastroenterologist can use the endoscope to treat the cause of bleeding as well.
- Other Procedures: Several other methods are available to locate the source of bleeding. Barium X rays, in general, are less accurate than endoscopy in locating bleeding sites. Another type of X ray is CT scan, particularly useful for inflammatory conditions and cancer. Angiography is a technique that uses dye to highlight blood vessels. This procedure is most useful in situations when the patient is acutely bleeding such that dye leaks out of the blood vessel and identifies the site of bleeding.
Treatment of bleeding in the digestive tract
- Active bleeding from the upper GI tract can often be controlled by injecting chemicals directly into a bleeding site with a needle introduced through the endoscope. Laser therapy is useful in certain specialized situations.
- Once bleeding is controlled, medicines are often prescribed to prevent recurrence of bleeding. Medicines are useful primarily for H. pylori, oesophagitis, ulcer, infections, and irritable bowel disease. Medical treatment of ulcers, including the elimination of H. pylori, to ensure healing and maintenance therapy to prevent ulcer recurrence can also lessen the chance of recurrent bleeding.
- Removal of polyps with an endoscope can control bleeding from colon polyps. Removal of haemorrhoids by banding or various heat or electrical devices is effective in patients who suffer haemorrhoidal bleeding on a recurrent basis. Endoscopic injection can be used to treat bleeding sites throughout the lower intestinal tract.
- Endoscopic techniques do not always control bleeding. Sometimes angiography may be used. However, surgery is often needed to control active, severe, or recurrent bleeding when endoscopy is not successful.