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What is Gastrointestinal Bleeding?Any bleeding that starts anywhere in the gastrointestinal tract- beginning from the mouth right up to the anus, is known as gastrointestinal bleeding. It may be a microscopic bleeding which often goes unnoticed and may lead to development of anemia, or it may be massive leading to emergency conditions like hypovolemia and shock. For all practical purposes, gastrointestinal bleeding has been divided into two types- upper GI bleeding and lower GI bleeding.
Upper Gastrointestinal Bleeding
Bleeding from any site proximal to the ligament of Treitz, i.e., from the esophagus, stomach or duodenum is called as upper GI bleeding. It is found in almost 100 cases per 100,000 population per year and is four times more common than the lower GI bleeding. The most common causes of upper GI bleed include:
- Peptic ulcer disease: Localized erosion of the mucus membrane lining the stomach or the duodenum is known as peptic ulcer disease. The erosion results in damage to the tiny blood vessels present in the mucus membrane which bleed upon coming in contact with the gastric acid. Peptic ulcer formation is precipitated by factors like use of non-steroidal anti-inflammatory drugs (NSAIDs), alcohol, spicy food, cigarette smoking and infection of Helicobacter pylori.
- Gastritis: Generalized inflammation of the stomach wall can lead to upper GI bleeding.
- Esophageal varices: Swelling of the veins of the esophagus because of liver cirrhosis is called esophageal varices. These veins can suddenly bleed heavily.
- Mallory Weiss tear: It is a tear in the esophageal or stomach wall due to forceful coughing, vomiting or retching. It may also result from the strain during childbirth or after seizures.
Lower Gastrointestinal Bleeding
Almost 24% of all cases of GI bleed are because of lower GI bleeding. It is associated with a mortality rate of 10 to 20%. Lower GI bleeding is more common in males and is usually seen in elderly patients with other major illnesses.
Lower GI bleeding originates from the small intestine, the large intestine, the rectum or the anus. Common conditions leading to a lower GI bleed include inflammatory bowel disease, infectious diarrhea, hemorrhoids, diverticulosis, angiodysplasia and polyps and cancers of the lower GI tract.
- Hemorrhoids: They are the swollen blood vessels around the rectum which bleed on straining at stool. You pass out fresh blood which is bright red in color. Anal fissures resulting from undue straining to pass out hard stools can also lead to bleeding.
- Polyps: They are non- cancerous growths found mainly in the GI tracts of old people. Some of them may turn cancerous. Polyps of the colon may bleed heavily at times.
- Angiodysplasia: They are the malformation of the blood vessels present in the wall lining the GI tract. They are common in large intestine of elderly and patients of chronic renal failure.