Gastrointestinal hemorrhage (GI hemorrhage) refers to bleeding in the gastrointestinal tract, which can occur at any point from the esophagus to the rectum. It is a potentially life-threatening condition requiring prompt diagnosis and treatment. This article explores the causes, symptoms, diagnostic methods, and treatment options for gastrointestinal bleeding.
Types of Gastrointestinal Hemorrhage
GI hemorrhage is categorized into upper GI bleeding (UGIB) and lower GI bleeding (LGIB) based on the location of bleeding:
- Upper GI Bleeding: Originates from the esophagus, stomach, or duodenum (proximal to the ligament of Treitz).
- Lower GI Bleeding: Originates from the jejunum, ileum, colon, or rectum.
Causes of Gastrointestinal Hemorrhage
Upper GI Bleeding Causes
- Peptic Ulcers: Most common cause, often due to Helicobacter pylori infection or NSAID use.
- Esophageal Varices: Common in liver cirrhosis patients, associated with portal hypertension.
- Mallory-Weiss Tear: Mucosal laceration at the gastroesophageal junction due to forceful vomiting.
- Gastritis: Inflammation of the stomach lining caused by alcohol, NSAIDs, or infection.
- Esophagitis: Often associated with gastroesophageal reflux disease (GERD).
- Gastric Cancer: Can cause chronic or acute bleeding.
Lower GI Bleeding Causes
- Diverticulosis: Painless bleeding from colonic diverticula, common in older adults.
- Colorectal Cancer: May present with occult bleeding or hematochezia.
- Hemorrhoids: Common cause of bright red rectal bleeding.
- Inflammatory Bowel Disease (IBD): Includes Crohn’s disease and ulcerative colitis.
- Angiodysplasia: Vascular malformations in the GI tract, often in the elderly.
Symptoms of Gastrointestinal Hemorrhage
- Hematemesis: Vomiting of bright red blood or coffee-ground material (UGIB).
- Melena: Black, tarry stools indicating digested blood (UGIB).
- Hematochezia: Bright red or maroon-colored stool (LGIB).
- Abdominal Pain: Depending on the underlying cause.
- Fatigue & Weakness: Due to chronic blood loss leading to anemia.
- Hypovolemic Shock: Severe cases may present with low blood pressure, tachycardia, and confusion.
Diagnosis of Gastrointestinal Hemorrhage
- Clinical Evaluation: History and physical examination.
- Laboratory Tests: Complete blood count (CBC), coagulation profile, and liver function tests.
- Endoscopy:
- Esophagogastroduodenoscopy (EGD): For UGIB evaluation.
- Colonoscopy: For LGIB evaluation.
- Imaging:
- CT Angiography: Detects active bleeding sources.
- Tagged Red Blood Cell Scan: Identifies slow GI bleeds.
- Capsule Endoscopy: Useful for small bowel bleeding.
Initial Management
- Stabilization: IV fluids, oxygen, blood transfusion if necessary.
- Proton Pump Inhibitors (PPIs): For suspected peptic ulcer bleeding.
- Octreotide & Antibiotics: For variceal bleeding.
Endoscopic Treatment
- Hemostasis Techniques:
- Injection therapy (epinephrine, sclerotherapy).
- Thermal coagulation.
- Hemoclips or band ligation (for varices).
Surgical & Radiological Interventions
- Angiographic Embolization: Used when endoscopic control fails.
- Surgery: Reserved for refractory bleeding cases.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): For portal hypertension-related bleeding.
Prevention of GI Hemorrhage
- H. pylori Eradication: Reduces peptic ulcer recurrence.
- Avoid NSAIDs & Alcohol: To prevent gastritis and ulcer formation.
- Screening for Varices: In patients with cirrhosis.
- Dietary & Lifestyle Changes: High-fiber diet for diverticulosis prevention.
Gastrointestinal hemorrhage is a medical emergency requiring prompt evaluation and treatment. Understanding its causes, symptoms, and management strategies improves patient outcomes. Early diagnosis via endoscopy and appropriate therapeutic interventions play a crucial role in preventing complications.
