Gastrointestinal (GI) bleeding is any type of bleeding that starts in the GI tract that composed from esophagus, stomach, small intestine, large intestine, rectum, and anus. GI bleeding is a symptom of a disease or condition, rather than a disease or condition itself. ​

Peptic ulcer, esophageal varices and hemorrhoids are major causes for GI bleeding. Other causes include cancers, inflammatory bowel diseases and angiodysplasia. The symptoms of that depend on the location and the severity of bleeding. Vomiting blood or a dark stool are two common of them.

Several diagnostic procedures are available to confirm the condition. Endoscopy can be used to investigate and treat most cases. It is considered very important to treat GI bleeding and its underlying cause as soon as possible, as it could lead to serious health complications if left untreated.

Gastrointestinal bleeding (also called “GI” bleeding) refers to a leak of blood from any part of the gastrointestinal tract. It is divided into 2 types based on its original location:

• Upper GI bleeding: includes the esophagus, stomach, and duodenum;
• Lower GI bleeding: much of the small intestine, all large intestine, rectum, and anus.

• Causes of Upper GI bleeding:
  • Peptic ulcers, mostly gastric (stomach) and duodenal ulcers;
  • Gastritis; an inflammation of stomach lining;
  • Esophageal and gastric varices;
  • Stomach cancer.
• Causes of lower GI bleeding:
  • Diverticular disease, which is a small out-pockets form in the wall of the colon;
  • Angiodysplasia; a malformation of the blood vessels in the wall of the GI tract;
  • Inflammatory bowel diseases, like crohn's disease and ulcerative colitis;
  • Hemorrhoids and anal fishers;
  • Tumors, especially colorectal cancer.

Several conditions increasing the risk of having major causes of GI bleeding, these include:

• Portal hypertension that occur usually as a result of blockage of liver vessels due to its damage by fibrosis or cirrhosis, which may lead to the formation of varices in the esophagus that are prone to explode and bleed;
•  Improper use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), like Ibuprofen. This include over using and taking of them on empty stomach, as it can increase the risk of an essential cause of GI bleeding; i.e. Peptic ulcers;
• Severe or prolong constipation. This can cause tearing in the anal tissue and formation of hemorrhoids;
• Smoking and alcohol drinking, as they affect gastric and duodenal lining in a way that increase the risk of ulcers.

Mild cases of GI bleeding may be asymptomatic. In more advanced cases some symptoms may be noticed, like:

•  Black tarry stool;
• Bleeding bright red blood from rectum;
• Vomiting of fresh blood or it may look like “coffee grounds”;
• Noticing small amounts of blood on stool or toilet paper;
• Having symptoms of anemia, like fatigue and shortness of breath, mostly in severe cases.

It is may be enough to base on symptoms and physical examination to diagnose some cases like bleeding from hemorrhoids and anal fissures, while more complicated ones need more tests and diagnostic procedures, as:

• Upper endoscopy: using a scope to inspect the esophagus, stomach and duodenum. The doctor may take biopsy for further study and in some cases control or treat the bleeding source;
• Colonoscopy: By a long, flexible tube, the physician can get video images of the rectum and colon. In some cases, bleeding can be controlled or treated during the procedure;
• Capsule endoscopy. The patient swallows a small pill containing a video camera, which transmits images of your small intestine to a recording device;
• Endoscopic ultrasound: An ultrasound probe attached to an endoscope allows doctors to see all the layers of tissue in the digestive tract;
• Multiphase CT enterography or magnetic resonance (MR) enterography: noninvasive radiologic tests, which are more sensitive than conventional X-rays for finding the source of GI bleeding. They can provide comprehensive images of the entire GI tract wall and layers of surrounding tissue;
• Angiography: After injection of a contrast dye into an artery, a series of X-rays are taken to fined and treat bleeding vessels or other abnormalities.

Dealing with GI bleeding depends on its cause and severity. Asymptomatic gastrointestinal bleeding detected on routine tests may only require supportive care, like iron-supplementation therapy while keep looking for the cause in order to treat it and avoid progression or possible complications.

However, in severe and active cases, treatment begins with blood transfusions and intravenous fluids as needed and ordered by doctor. These situation needs urgent intervention by endoscopy and its therapies that include: epinephrine injection, thermocoagulation (treat the bleeding site and surrounding tissue with a heat probe), application of clips, and banding.

In cases of peptic ulcers as etiology for GI bleeding - that often caused by H. pylori - is treated using the triple therapy, which consists of two different antibiotics and an acid-suppressing drug, mainly a proton pump inhibitor. These drugs are given for specific period, then a test for confirmation done at least four weeks after the treatment. If it showed the treatment was unsuccessful, another round of treatment is needed with a different combination of antibiotics.

Colon polyps, tumor or affected areas of inflammatory bowel disease may require surgical resection of disease fragments or diseased parts. Hemorrhoids and anal fissures may respond to topical and habitual treatments such as ointments, sitz bath and controlling constipation. However, sometimes they may require surgical intervention or even endoscopic coagulation or clipping.

GI bleeding runs inside the body, so it can go unnoticed for a long period, or it could be severe enough to cause life-threatening consequences even in short period. Prolonged or massive bleeding can cause certain complications. These include:

• Anemia: Prolonged bleeding even in little amounts can lead to the loss of iron and red blood cells. Symptoms of anemia include chest pain, fatigue, paleness, and shortness of breath;
• Hypovolemia: severe loss of blood and fluid in acute GI bleeding can decrease the volume of blood so the heart finds it difficult to pump enough blood to the body which can affects body's organs functions;
• Shock: Massive bleeding from the GI tract can lead to losing enough circulating red blood cells to compromise oxygen and nutrients delivery to cells. Shock requires immediate treatment and can get worse very rapidly leading to organ damage. This condition kills nearly 20% of people who suffer from it.

Some cases are associated with an increased mortality, recurrent bleeding, the need for endoscopic hemostasis, or surgery. Risk factors for GI bleeding complications include:

• Age older than 60 years;
• Severe comorbidity;
• Active bleeding;
• Hypotension;
• Blood transfusion ≥ 6 units;
• Severe coagulopathy.

Detecting and treating the conditions that cause the bleeding GI bleeding is the cornerstone for avoidance of that health problem. Some ways that reduce the risk are:

• Limiting nonsteroidal anti-inflammatory drugs (NSAIDs) intake or talking with the doctor about other medicine options;
• Following doctor’s recommendations for treatment of gastroesophageal reflux. This may need taking some medications;
• Trying to avoid constipation through high intake of water and fiber rich food, such as fruits, vegetables and whole grains;
• Obviating possible triggers, such as alcohol and smoking that increase gastric secretions;
• Screening: Beginning at age 50, regular screening is considered the key to preventing colorectal cancer and removing polyps; possible causes of GI bleeding.

This condition is associated with significant morbidity and mortality. Patients of advanced age and patients with comorbid conditions are at the greatest risk. One or more comorbid illnesses have been noted in 98.3% of mortalities in upper GI bleeding and considered as the primary cause of death for 72.3% of them. Identification of the bleeding point is the most important initial step in treatment; once the bleeding point is localized, the treatment options are straightforward and curative. The chance of recurrence is diminished if the underlying disease has been fixed.

The incidence of GI bleeding is greater in males than in females, in all age groups; however, the death rate is similar in both sexes. Worldwide, acute lower GI bleeding accounts for 1-2% of hospital emergencies, with 15% of these presenting as massive bleeding and about 5% requiring operative intervention.