What should you do if you think you’re having a GI bleed? Just don’t ignore the problem

Gastrointestinal (GI) bleeding is a symptom, not a disease by itself. The source of blood loss can be anywhere in the digestive tract, from the esophagus to the rectum.

When the amount of blood lost is large, that loss itself is dangerous even if the underlying cause is benign.

But even small amounts of blood loss can be due to a serious condition such as colon cancer.

Symptoms depend on how much blood is lost, the rapidity with which the loss occurs, and the source of the blood.

There may be no symptoms at all if you lose blood slowly in small amounts, and the blood loss may be discovered only when blood work reveals an unexpected anemia or a stool test is positive.

It can’t be ignored because it could be the first sign of a serious underlying condition.

Blood loss not visible to the naked eye and not associated with any symptoms is called occult blood loss. If this progresses unnoticed to the point where the blood loss is severe, patients develop symptoms related to the anemia itself: shortness of breath, pale skin, weakness, ankle swelling and even heart failure as the overworked heart works overtime attempting to circulate more blood to supply the body’s oxygen needs. A healthy person can become severely anemic before developing any symptoms at all, while someone with heart or lung disease will feel ill with a lower level of anemia.

Faster rates of bleeding show up in the stool. Blood coming from very low in the intestinal tract (lower colon or rectum) is bright red and coats the outside of the stool. Blood from sources higher in the colon is also usually darker red and mixed with the stool. Blood from the upper intestinal tract (small bowel, stomach, esophagus) often appears black in the stool, resembling coffee grounds. Because blood irritates the stomach, bleeding from the upper intestinal tract may cause vomiting. Vomited blood is bright red when fresh but resembles dark coffee grounds if it has sat for a while in the stomach.

Certain substances in the stool mimic GI bleeding. Beets, and foods loaded with red food colorings can look like red blood. Pepto-Bismol is a very common cause of black stools. Your doctor can differentiate between true blood loss and a look-alike condition with a quick chemical test.

Starting from above, common causes of bleeding from the esophagus include varices and tears. Esophageal varices are dilated veins usually caused when cirrhosis alters the pressure in the veins located in the walls of the esophagus. Severe vomiting and retching may cause what are termed Mallory-Weiss tears in the esophagus.

Next in line is the stomach, where two common causes of bleeding are gastritis and gastric ulcers. I like to compare gastritis to an all-over sunburn of the skin; large portions of the lining are inflamed. An ulcer is similar to a deep sunburn with blistered areas; actual areas of the stomach lining are eroded away. Causes of ulcers and gastritis include alcohol, aspirin, nonsteroidal anti-inflammatory agents, infections with the bacteria “Helicobacter pylori,” and serious medical stress (e.g. head injuries, burns, shock, cancer).

In the small intestine the most common cause of bleeding is a duodenal ulcer. Like gastric ulcers these are associated with “Helicobacter pylori” and certain medicines.

The colon, or large intestine, is frequently the site of polyps or cancers that bleed. With age many people develop diverticulae, tiny outpocketings of the colon, which can bleed from nearby blood vessels in the bowel wall. Other causes of colonic bleeding include inflammatory bowel disease (Crohn’s disease and ulcerative colitis), infections, dilated blood vessels (sometimes hereditary as in Osler-Weber-Rendu syndrome), and hemorrhoids.

To determine the cause, your doctor will, as always, start with a history and physical exam. Diagnostic tests will likely include a direct look at your intestinal tract. The lower portion can be viewed with a colonoscopy, and an upper endoscopy can take a look down into the esophagus, stomach, and duodenum (first part of the small bowel.)

Of course, the correct treatment depends on the underlying cause and severity of the bleeding.
What should you do if you think you’re having a GI bleed? Don’t ignore it!

If the bleeding is minimal— a few spots of blood on the stool, and no associated symptoms, call your doctor to schedule an appointment to be seen soon. But if the bleeding is severe go directly to the emergency room, and don’t hesitate to go by ambulance for severe symptoms.

What does G.I. bleeding look like?
• Bright red blood on the stools
• Dark red blood mixed with the stools
• Black or tarry stools
• Bright red blood in vomited material
• Black material resembling coffee-grounds in vomit

What signs can acute G. I. bleeding cause?
• Any of the above bleeding symptoms
• Abdominal pain and cramps
• Weakness, faintness, and/or dizziness
• Shortness of breath
• Diarrhea

What are the signs of chronic G.I. bleeding?
• Any of the above symptoms
• Lethargy
• Ankle swelling