Gastrointestinal bleeding | |
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Other names | Gastrointestinal hemorrhage, GI bleed |
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A positive fecal occult blood test | |
Specialty | Gastroenterology ![]() |
Symptoms | Vomiting red blood, vomiting black blood, bloody stool, black stool, fatigue[1] |
Complications | Iron-deficiency anemia, heart-related chest pain[1] |
Types | Upper gastrointestinal bleeding, lower gastrointestinal bleeding[2] |
Causes | Upper: peptic ulcer disease, esophageal varices due to liver cirrhosis, cancer[3] Lower: hemorrhoids, cancer, inflammatory bowel disease[2] |
Diagnostic method | Medical history and physical examination, blood tests[1] |
Treatment | Intravenous fluids, blood transfusions, endoscopy[4][5] |
Medication | Proton pump inhibitors, octreotide, antibiotics[5][6] |
Prognosis | ~15% risk of death[1][7] |
Frequency | Upper: 100 per 100,000 adults per year[8] Lower: 25 per 100,000 per year[2] |
Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum.[9] When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.[1] Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain.[1] Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out.[1][9] Sometimes in those with small amounts of bleeding no symptoms may be present.[1]
Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding.[2] Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others.[3] Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.[2][1] Small amounts of bleeding may be detected by fecal occult blood test.[1] Endoscopy of the lower and upper gastrointestinal tract may locate the area of bleeding.[1] Medical imaging may be useful in cases that are not clear.[1] Bleeding may also be diagnosed and treated during minimally invasive angiography procedures such as hemorrhoidal artery embolization.[10][11]
Initial treatment focuses on resuscitation which may include intravenous fluids and blood transfusions.[4] Often blood transfusions are not recommended unless the hemoglobin is less than 70 or 80 g/L.[7][12] Treatment with proton pump inhibitors, octreotide, and antibiotics may be considered in certain cases.[5][6][13] If other measures are not effective, an esophageal balloon may be attempted in those with presumed esophageal varices.[2] Endoscopy of the esophagus, stomach, and duodenum or endoscopy of the large bowel are generally recommended within 24 hours and may allow treatment as well as diagnosis.[4]
An upper GI bleed is more common than lower GI bleed.[2] An upper GI bleed occurs in 50 to 150 per 100,000 adults per year.[8] A lower GI bleed is estimated to occur in 20 to 30 per 100,000 per year.[2] It results in about 300,000 hospital admissions a year in the United States.[1] Risk of death from a GI bleed is between 5% and 30%.[1][7] Risk of bleeding is more common in males and increases with age.[2]
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