Posted inAcid Reflux / GERD Crohn's / IBD Emergency Medicine GastroIntestinal / Gastroenterology

Upper GI bleed: What you should know

May 14, 2021
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Upper gastrointestinal (GI) bleeding happens when there is bleeding in the oesophagus, stomach, or upper portion of the small intestine. It’s a sign of something else going on, and it can be dangerous.

An upper GI bleed sends over 100,000 people to the hospital in the United States every year. Severe bleeds can be life-threatening and must be treated right away.

We’ll take a closer look at upper GI bleeds in this post, including their causes and treatment options.

Definition

Blood test results

When a portion of the upper digestive tract is damaged or inflamed, it can cause a bleed.

A GI bleed is a symptom of another disorder rather than a health condition in itself. GI bleeds are classified as upper or lower bleeds, depending on the source of the blood.

Lower GI bleeds can occur in the:

  • lower part of the small intestine
  • colon
  • rectum
  • anus

Upper GI bleeds can occur in the:

  • esophagus
  • stomach
  • duodenum, the initial part of the small intestine

GI bleeds can be acute or chronic. Acute bleeds are sudden and serious, while recurrent bleeding occurs over time and is usually less noticeable. If not treated, both of these conditions can lead to serious health problems.

Causes

Upper GI bleeding can be caused by a variety of factors. There are some of them:

Peptic ulcer

Peptic ulcers are sores that form on the stomach and upper portion of the small intestine lining. A Helicobacter pylori infection or inflammation from nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin or ibuprofen are the most common causes.

Many people who have ulcers have no symptoms. If symptoms do appear, they can include the following:

  • pain, often in the upper abdomen
  • nausea or vomiting
  • feeling full or bloated

Esophagitis

Esophagitis is a condition in which the oesophagus becomes inflamed. Gastroesophageal reflux disease (GERD) is the most common cause, but it may also be caused by drugs, viruses, and allergies.

The symptoms of esophagitis include:

  • pain in the chest when swallowing
  • difficulty swallowing
  • nausea or vomiting
  • lack of appetite
  • chronic cough

If a person has GERD, they may experience heartburn and acid reflux on a regular basis.

Enteritis

When the small intestine becomes inflamed, usually as a result of a bacterial or viral infection, enteritis develops. Radiation therapy, some drugs, alcohol, or inflammatory bowel disease (IBD) may all cause enteritis .

Nausea, vomiting, diarrhoea, cramping, and rectal bleeding may occur when enteritis is caused by an infection.

Mallory-Weiss tears

There are tears in the oesophageal lining that occur often as a result of excessive vomiting or coughing.

Mallory-Weiss tears may result in a significant amount of bleeding. While they can recover on their own in certain cases, this isn’t always the case. Some people may need medical help to stop the bleeding and prevent serious blood loss.

Esophageal varices

Esophageal varices are swollen veins that can form at the esophagus’s lower end. They’re most common in people who have cirrhosis, a type of liver disease.

Symptoms of oesophageal varices typically do not appear until the veins begin to bleed. If these blood vessels bleed, they may bleed profusely. Among the signs and symptoms are:

  • stomach pain
  • vomiting blood
  • bloody stool

Gastritis

Gastritis is a stomach inflammation. The majority of people with gastritis have no symptoms, but it can lead to the following:

  • pain in the upper abdomen
  • feeling full after eating little
  • loss of appetite
  • unintentional weight loss

Gastritis can lead to ulcers or damage to the stomach lining, resulting in bleeding. NSAID use, illness, IBD, or infection may all cause this condition.

Cancer

Cancer is a less common cause of upper GI bleeding. The following are some of the most common oesophageal cancer symptoms:

  • difficulty swallowing
  • a persistent cough
  • vomiting blood
  • heartburn
  • unexplained weight loss

Cancer may also manifest itself elsewhere in the upper GI tract, causing bleeding.

Symptoms

The type of symptoms a person can experience are influenced by the location of a GI bleed and the rate of bleeding.

The symptoms of a GI bleed can include:

  • black, tarry stool
  • vomit that is bright red or resembles coffee grounds
  • stomach cramps
  • unusually pale skin
  • feeling faint, dizzy, or tired
  • weakness

Occult bleeding, which happens when blood is present in the stool but is not noticeable, may also occur. A stool test may be used to detect this blood.

When do you seek assistance?

Acute GI bleeding can rapidly escalate into a serious situation. If a person shows symptoms of a GI bleed unexpectedly, they should seek medical attention right away.

Acute GI bleeds can also cause shock, which is a life-threatening condition. Among the signs and symptoms are:

If a person exhibits these symptoms, they should call 911 or the nearest emergency room.

Chronic GI bleeding is a form of gastrointestinal bleeding that lasts for a long time or comes and goes. However, it can also cause serious health problems, such as anaemia.

When exercising, people with anaemia sometimes feel lightheaded, exhausted, or short of breath. It’s also possible that they’ll appear paler than normal.

Anyone who thinks they could be suffering from a chronic GI bleed or anaemia should see a doctor as soon as possible to get a diagnosis and treatment.

Diagnosis

If a doctor thinks bleeding is the cause of a patient’s symptoms, he or she may take a medical history and conduct a physical examination. They can then enquire about the individual’s symptoms, as well as their bowel movements and stool colour.

The doctor can also refer the patient to a gastroenterologist or order diagnostic tests. They may use a variety of tests to aid in their diagnosis, including:

  • Stool tests: These can detect inflammation, occult bleeding, or infections, such as H. pylori.
  • Blood tests: These tests can reveal anemia.
  • Upper endoscopy or enteroscopy: A doctor passes an endoscope down the esophagus to view the stomach or small intestine.
  • Gastric lavage: This procedure involves removing the contents of the stomach to determine the source of any bleeding.
  • A biopsy: A doctor will take a small sample of tissue from an affected area and send it to a lab for analysis.
  • Imaging tests: Examples include CT scans and barium X-rays.

Medications

The treatment options for an upper GI bleed are determined by a number of factors, including the location, severity, and cause of the bleeding.

The goal for people who go to the emergency room with serious bleeds is to stop the bleeding. Doctors can accomplish this by:

  • injecting a medication directly into the bleeding site
  • using heat to treat the bleeding site via a probe or laser
  • placing a clip on the blood vessel to seal it shut

If doctors locate the source of the bleed during medical tests such as an endoscopy, they may use one of these methods.

The next move is to address the underlying cause of the bleeding. This treatment may include:

  • taking medications to treat underlying conditions, such as antibiotics to clear an H. pylori infection or proton pump inhibitors (PPIs) to suppress stomach acid production and allow ulcers to heal
  • stopping any medications or practices that are causing ulceration or bleeding, such as NSAID use
  • surgery, which a doctor may recommend if they cannot stop the bleeding in other ways

Intravenous fluids or a blood transfusion may be needed for people who have lost a lot of blood.

Risk factors and how to avoid them

The conditions that can cause GI bleeds are caused by a variety of factors.

GERD is more common in people who smoke, are pregnant, or are obese, for example. It may also be exacerbated by such drugs, such as:

  • NSAIDs
  • calcium channel blockers
  • benzodiazepines
  • tricyclic antidepressants

If a drug is worsening ulcers or bleeding, a person should consult a doctor about other options or dosage adjustments. It is important, however, to never alter the dose without first consulting a medical professional.

A doctor may assist a patient in determining the cause of a GI bleed as well as how to treat or handle it. This method is normally the most effective at preventing further bleeds.

People who have had GI bleeds or ulcers in the past will reduce their risk of GI bleeding by:

  • avoiding alcohol
  • stopping smoking, if a smoker, or avoiding secondhand smoke
  • limiting or stopping the use of NSAIDs

Certain dietary changes can also help people with GERD relieve their symptoms by reducing pain and inflammation. People should try avoiding:

  • caffeine
  • minty, spicy, or acidic foods
  • high fat foods

Conclusion

Sudden and severe GI bleeding is a medical emergency, but slower, chronic bleeding can also become serious over time. Anyone who thinks they have a GI bleed should seek medical attention as soon as possible.

Doctors may use drugs to avoid or monitor upper GI bleeding, or they can use heat or surgery to close wounds. The underlying condition should then be treated to avoid further bleeding.

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Last updated on May 14, 2021