|
Bleeding in the digestive tract is a symptom
of digestive problems rather than a disease itself. Most causes of bleeding are
related to conditions that can be cured or controlled, such as hemorrhoids. The cause of bleeding may not be serious, but locating the
source of bleeding is important. The digestive or gastrointestinal (GI) tract
includes the esophagus, stomach, small intestine, large intestine or colon,
rectum and anus. Bleeding can come from one
or more of these areas: 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.
What causes bleeding in the digestive tract?
Stomach acid can cause inflammation that may lead to bleeding at the lower
end of the esophagus. This condition is called esophagitis or inflammation of
the esophagus. 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 gastroesophageal reflux disorder or GERD, an inflammatory esophageal condition. In addition, enlarged veins
(varices) at the lower end of the esophagus
may rupture and bleed massively. Cirrhosis of the liver is the
most common cause of esophageal varices.
Esophageal bleeding can be caused by Mallory-Weiss syndrome, a tear in the
lining of the esophagus. Mallory-Weiss syndrome usually results from prolonged
vomiting but also may be caused by increased pressure in the abdomen from
coughing, a hiatal hernia or childbirth. The stomach is a frequent site of
bleeding. Alcohol, aspirin, aspirin-containing medicines, and
various other medicines (particularly those used for arthritis) can cause
stomach ulcers or inflammation (gastritis). The stomach often is the site of
ulcer disease. Acute or chronic ulcers may enlarge and erode
through a blood vessel, causing bleeding. Also, patients suffering from burns,
shock, head injuries or cancer, or those who have undergone extensive surgery,
may develop stress ulcers.
Bleeding can occur from benign tumors or from cancer of the stomach, although
these disorders usually do not cause massive bleeding. The most common source of
bleeding from the upper digestive tract is ulcers in the duodenum (the upper
small intestine). Researchers now believe that these ulcers are caused by excess
stomach acid and infection with Helicobacter pylori bacteria.
In the lower digestive tract, the large intestine and rectum are frequent
sites of bleeding. Hemorrhoids probably are the most common
cause of visible blood in the digestive tract, especially blood that appears
bright red. Hemorrhoids are enlarged veins in the anal area that can rupture and
produce bright red blood, which can show up in the toilet or on toilet paper. If
red blood is seen, however, it is essential to exclude other causes of bleeding
because the anal area may also be the site of fissures, inflammation or tumors.
Benign tumors or polyps of the colon are common and
may be forerunners of cancer.
Colorectal cancer is the third leading cause of
cancer and cancer deaths in American men and women and may cause bleeding
at some time. Inflammation from various causes can produce extensive bleeding
from the colon. Different intestinal infections can cause inflammation and
bloody diarrhea. Ulcerative colitis can produce inflammation
and extensive surface bleeding from tiny ulcerations. Crohn's disease of the large intestine also can produce spotty bleeding. Diverticular
disease caused by diverticula —outpouchings of the colon
wall — can result in massive bleeding. Finally, as one gets older,
abnormalities may develop in the blood vessels of the large intestine, which may
result in recurrent bleeding.
How is bleeding in the digestive tract recognized?
The signs of bleeding in the digestive tract depend on the site and severity
of bleeding. If blood is coming from the rectum or the lower colon, bright red
blood will coat or mix with the stool. The stool may be mixed with darker blood
if the bleeding is higher up in the colon or at the far end of the small
intestine. When there is bleeding in the esophagus, stomach or duodenum, the
stool is usually black or tarry. Vomit may be bright red or have a
"coffee-grounds" appearance when bleeding is from the esophagus,
stomach or duodenum.
If bleeding is occult, or hidden, the patient might not notice any changes in
stool color. If sudden massive bleeding occurs, a person may feel weak, dizzy,
faint, short of breath, or have crampy abdominal pain or diarrhea. Shock may
occur, with a rapid pulse, drop in blood pressure and difficulty in producing
urine. The patient may become very pale. If bleeding is slow and occurs over a
long period of time, a gradual onset of fatigue, lethargy, shortness of breath
and pallor from anemia will result. Anemia is a condition in
which the blood's iron-rich substance, hemoglobin, is diminished.
What are the common causes of bleeding in the digestive tract?
- Hemorrhoids
- Inflammation (gastritis)
- Inflammation (ulcerative colitis)
- Colorectal cancer
- Colorectal polyps
- Diverticular disease
- Duodenal ulcer
- Enlarged veins (varices)
- Esophagus inflammation (esophagitis)
- Mallory-Weiss syndrome
- Ulcers
In addition, iron and some foods, such as beets, can give the stool a red or
black appearance, falsely indicating blood in the stool.
How is bleeding in the digestive tract diagnosed?
The site of the bleeding must be located. A complete history and physical
examination are essential, and directs the rest of the patient work-up. Bright
red bleeding seen on the toilet paper or in the toilet water usually is coming
from the hemorrhoid area. Endoscopy is therefore performed on the anus, rectum
and lower colon (sigmoid). Dark blood or blood mixed with the stool usually is
coming from the colon, and colonoscopy is recommended. Occult blood could be
coming from anywhere in the gastrointestinal tract. Endoscopy usually checks the
colon first. If that is normal, then the esophagus and stomach are inspected.
Hemorrhage, or massive bleeding, can be from the stomach and esophagus, or from
the small intestine, colon or rectum. It is difficult to check the lower
intestine while the bleeding is occurring, but endoscopy of the stomach and
esophagus can be performed.
Symptoms such as changes in bowel habits, stool color (black or red), stool
consistency and the presence of pain or tenderness may tell the doctor which
area of the GI tract is affected. Because the intake of iron or foods such as
beets can give normal stool the same appearance as stool with bleeding from the
digestive tract, a doctor must test the stool for blood before offering a
diagnosis. A blood count will indicate whether the patient is anemic and also
will give an idea of the extent of the bleeding and how chronic it may be.
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 doctor can
use the endoscope to treat the cause of bleeding as well.
The endoscope is a flexible instrument that can be inserted through the mouth
or rectum. The instrument allows the doctor to see into the esophagus, stomach,
duodenum (esophago-duodenoscopy), entire colon (colonoscopy), sigmoid colon
(sigmoidoscopy) and rectum (rectoscopy) to collect small samples of tissue
(biopsies); to take photographs and to stop the bleeding. Small-bowel endoscopy,
or enteroscopy, is a new procedure using a long endoscope. This endoscope may be
introduced during surgery to localize a source of bleeding in the small
intestine.
Capsule endoscopy
A capsule is swallowed and records pictures along the gastrointestinal
tract. By reviewing the pictures, a bleeding lesion can be located.
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.
Some drawbacks of barium X-rays are that they may interfere with other
diagnostic techniques if used for detecting acute bleeding; they expose the
patient to X-rays and they do not offer the capabilities of biopsy or treatment.
Hemorrhage, or massive blood loss, requires other types of tests, in addition
to endoscopy. These are angiography and radionuclide scanning.
Angiography is a technique that uses dye to
highlight blood vessels. This procedure 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. In selected situations,
angiography allows injection of medication that may stop the bleeding.
Radionuclide scanning is a non-invasive screening technique used for
locating sites of acute bleeding, especially in the lower GI tract. This
technique involves injection of small amounts of radioactive material that are
either attached to the patient’s red blood cells or are in a suspension in the
blood. Then, a special camera produces pictures of organs, allowing the doctor
to see the blood escaping. In addition, barium X-rays, angiography and
radionuclide scans can be used to locate sources of chronic occult bleeding.
These techniques are especially useful when the small intestine is suspected as
the site of bleeding, since the small intestine may not be seen easily with
endoscopy.
How is bleeding in the digestive tract treated?
The use of endoscopy has grown and now allows doctors not only to see
bleeding sites but to directly apply therapy as well. A variety of endoscopic
therapies are useful for treating GI tract bleeding. Active bleeding from the
upper GI tract often can be controlled by injecting chemicals directly into a
bleeding site using a needle introduced through the endoscope. A physician also
can cauterize, or heat treat, a bleeding site and surrounding tissue with a
heater probe or electrocoagulation device passed through the endoscope. Laser
therapy, although effective, is no longer used regularly by many physicians
because it is expensive and cumbersome.
Once bleeding is controlled, medications often are prescribed to prevent
recurrence of bleeding. Medical treatment of ulcers to ensure healing and
maintenance therapy to prevent ulcer recurrence also can lessen the chance of
recurrent bleeding. Studies are now under way to see if elimination of
Helicobacter pylori affects the recurrence of ulcer bleeding. 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 hemorrhoidal bleeding on a recurrent basis. Endoscopic injection or
cautery can be used to treat bleeding sites throughout the lower intestinal
tract. Endoscopic techniques do not always control bleeding, and sometimes
angiography may be needed. However, surgery often is required to control active,
severe or recurrent bleeding when endoscopy is not successful.
How to recognize blood in the stool and vomit
- Bright red blood coating the stool
- Dark blood mixed with the stool
- Black or tarry stool
- Bright red blood in vomit
- "Coffee-grounds" appearance
of vomit
Symptoms of acute bleeding
- Weakness
- Shortness of breath
- Dizziness
- Crampy abdominal pain
- Feeling faint
- Diarrhea
Symptoms of chronic bleeding
- Fatigue
- Shortness of breath
- Lethargy
- Pallor
Information adapted from the National Digestive Diseases Information
Clearinghouse
|
