Gastrointestinal bleeding shouldn%26rsquo;t be observed as a disease, but rather as a symptom. It is an extremely common condition, and causes of the bleeding are often related to conditions that can be cured or controlled, such as hemorrhoids.
The digestive or gastrointestinal tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from one or more of these areas, and sometimes occurs without the person even noticing it. Probably the best method for the diagnosis is a simple detection of blood in the stool.
The most common causes of gastrointestinal bleeding are hemorrhoids, inflammation, colorectal cancer and polyps, diverticular disease, and duodenal ulcer.
Possible causes of bleeding in the digestive tract
%26bull; Esophagitis: Stomach acid can cause an inflammation of the lower part of the esophagus (food pipe) which can lead to bleeding. This condition is called esophagitis. It does not normally occur, but sometimes a muscle between the esophagus and stomach fails to close properly and allows the return of food and stomach juices into the esophagus, which can lead to gastro-esophageal reflux disorder. In this condition, enlarged veins at the lower end of the esophagus may rupture and bleed massively.
%26bull; Mallory-Weiss syndrome: Esophageal bleeding can also be caused by Mallory-Weiss syndrome, indicating a tearing in the lining of the esophagus. This tear usually results from prolonged vomiting, but also may be caused by increased pressure in the abdomen from coughing, a hiatal hernia, or childbirth.
%26bull; Medications and gastric ulcer: The stomach is a frequent site of bleeding.
Many medications, particularly aspirin-containing ones, can cause stomach ulcers or inflammation, as can the consumption of alcohol. The stomach is also often the site of ulcer disease. Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding. The most common source of bleeding from the upper digestive tract is ulcers in the duodenum.
%26bull; Tumors: Bleeding can also occur from benign tumors or from cancer of the stomach, but these tumors cause massive bleeding extremely rarely.
%26bull; Hemorrhoids: Representing probably the most common cause of visible blood in the digestive tract, hemorrhoids are in fact enlarged veins in the anal area.
%26bull; Colorectal cancer: This is the third leading cause of cancer and cancer-related deaths in American men and women. It may also cause bleeding at some point.
A number of other conditions can also cause gastrointestinal bleeding, including ulcerative colitis, Crohn's disease, diverticular disease, etc.
How is bleeding in the digestive tract recognized?
Signs of bleeding in the digestive tract vary significantly depending on sites of bleeding, as well as the severity. If blood is coming from the rectum or the lower colon, bright red blood will coat or mix with the stool, but when there is bleeding in the esophagus, stomach, or duodenum, the stool will be black or tarry. This is because blood, while passing through intestine, will be digested. When the bleeding is hidden, the patient might not notice any changes in stool color but may feel weak, dizzy, faint, short of breath, or have abdominal pain or diarrhea.
How is bleeding in the digestive tract diagnosed?
The main diagnostic problem is to locate the site of the bleeding. That%26rsquo;s why a complete history and physical examination could be essential in order to set the appropriate diagnosis. As mentioned before, bright red bleeding seen on the toilet paper or in the toilet water usually comes from the hemorrhoid area, which means lower colon or anal region. In this case the best thing to do is to perform an endoscopy on the anus, rectum, and lower colon. The problem is that this hidden or occult blood could be coming from anywhere in the gastrointestinal tract. That%26rsquo;s why a professional will always use an endoscopy to check the colon first, and if that is normal, only then should the esophagus and stomach be inspected.
Hemorrhage, or massive bleeding, can be from the stomach and esophagus, or from the small intestine, colon or rectum and in that case, the stool will be black and tarry. Since the intake of iron can give normal stool the same appearance as stool with bleeding from the digestive tract, this should be also taken into consideration.
Endoscopy
Endoscopy is an extremely common diagnostic technique that allows direct viewing of the bleeding site. Although very simple, this is probably the best diagnostic tool because the endoscope can detect lesions and confirm the presence or absence of bleeding directly. The endoscope is a flexible instrument that can be inserted through the mouth or rectum easily, and allows the doctor to see into the esophagus, stomach, duodenum, entire colon, sigmoid colon, and rectum to collect small samples of tissue (biopsies). This could be extremely useful in setting the right histological diagnosis.
Other procedures
Several other methods are available to locate the source of bleeding.
%26bull; Barium X-rays: Some doctors prefer the barium x-ray diagnostic tool, less accurate tool than endoscopy in locating bleeding sites, but also extremely effective. The barium is swallowed before the imaging and, if there are no lesions in the GI tract, the contrast will nicely cover all the GI walls. However, barium X-rays may interfere with other diagnostic techniques if used for detecting acute bleeding.
%26bull; Angiography: Also used to diagnose bleeding, angiography is a special technique that uses dye to highlight blood vessels. It is most useful in situations where the patient is acutely bleeding in a way that allows the dye to leak out of the blood vessel, which identifies the site of bleeding.
%26bull; Radionuclide scanning: Some doctors prefer the radionuclide scanning to visualize the bleeding. This technique is also used for locating sites of acute bleeding, and involves an injection of small amounts of radioactive material, after which a special camera produces pictures of organs, allowing the doctor to see the blood escaping.
Treatment of gastrointestinal bleeding
Endoscopy isn%26rsquo;t just a diagnostic tool, but also a therapeutic one; there is a great number of endoscopic therapies useful for treating GI tract bleeding. Injecting special chemicals into the bleeding site using a needle introduced through the endoscope is an extremely useful therapeutic method. The doctor can also cauterize, or heat treat, a bleeding site and surrounding tissue with a heater probe or electro-coagulation device. Some doctors also use laser therapy to stop bleeding.
What to do after the bleeding had been stopped?
When the bleeding is brought under control, medications are usually prescribed to prevent recurrence of bleeding. Medical treatment of the underlying disease, such as ulcers, to ensure healing and maintenance therapy to prevent ulcer recurrence also can lessen the chance of recurrent bleeding. The removal of polyps with an endoscope can control bleeding from colon polyps. Removal of hemorrhoids by banding, or various heat or electrical devices is effective in patients who suffer hemorrhoid bleeding on a recurrent basis.
How to recognize blood in the stool and vomit
%26bull; Black or tarry stool
%26bull; Bright red blood in vomit
%26bull; black-grounds appearance of vomit
%26bull; Bright red blood coating the stool
%26bull; Dark blood mixed with the stool
Symptoms of acute bleeding
%26bull; Dizziness
%26bull; Crampy abdominal pain
%26bull; Feeling faint
%26bull; Diarrhea
%26bull; Weakness
%26bull; Shortness of breath
Symptoms of chronic bleeding
%26bull; Lethargy
%26bull; Pallor
%26bull; Fatigue
%26bull; Shortness of breath
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