Gastrointestinal Bleeding Or Blood In The Stool - What Does It Mean?

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.

Symptoms, Diagnostic Tests and Prevention of Gastrointestinal Bleeding

Symptoms of Gastrointestinal Bleeding

A patient of gastrointestinal bleed usually presents with complains of blood in vomit or blood in stools.

Blood present in vomit may be bright red in color, a condition called as hemoptysis or of coffee ground color, a condition called as hematemesis. “Hemoptysis” is vomiting of swallowed blood and is associated with coughing. It is normally due to epistaxis and should not be confused as a GI bleed. “Hematemesis”, on the other hand is of the color of a coffee ground and is a result of GI bleeding.

The patient may also complain of blood in stools. The stools may be of a black, tarry color and sticky in nature which is indicative of an upper GI bleeding. This type of blood in stools is called as “melena.” Any pathology in the colon, rectum or anus gives rise to bright red blood in stools, also known as “hematochezia.”

Apart from these, the patient may appear pale, or complain of shortness of breath. The patient may also complain of severe pain in the abdomen. In case of long term GI bleed which has remained unobserved by the patient, he may appear weak and fatigued. In case of a massive GI bleed, the patient may present with hypovolemia and in a state of shock. The situation can be fatal and requires emergency medical care.

Diagnostic Tests for Gastrointestinal Bleeding

After taking a complete medical history, a patient complaining of blood in stools will normally be subjected to a digital rectal examination. This is done to assess the exact site of bleeding (hemorrhoids, anal fissures, etc) or the cause of bleeding (any abnormal growth in the rectum or anus).

The doctor may like to do an upper or a lower GI endoscopic examination (UGIE or LGIE) to localize the site of bleeding. During this examination, he can visualize your GI tract with the help of a camera. Endoscopic examination can be both diagnostic as well as therapeutic wherein the doctor may try to control the bleeding by various means such as ligation, cauterization or injecting a sclerosing agent.

The patient is also subjected to certain lab tests to determine the reasons behind the bleeding.

Newer techniques like angiography and bleeding scan provide less invasive means of controlling the bleed.

Can Gastrointestinal Bleeding be prevented?

Though it is not entirely in our hands to prevent gastrointestinal bleeding, we can definitely take measures to reduce its instance. Bleeding because of peptic ulcer disease can be prevented to a large degree by avoiding spicy food, alcohol and smoking. Bleeding from hemorrhoids and diverticulosis can be reduced by including a lot of fiber in the diet which facilitates an easy passage of stools.

Gastrointestinal bleeding, though alarming, is a fairly common condition which can be brought under control if prompt medical care is sought. Many people suffering from hemorrhoids, anal fissures, etc are ashamed of seeking medical help and delay treatment for a long time. Heavy bleeding can be avoided if treatment is taken at an initial stage itself. Avoid factors like smoking, etc and consult your doctor, no matter if you pass even a small quantity of blood in your vomit or stools. A prompt diagnosis and early treatment can go a long way in preventing medical emergencies.