Upper gastrointestinal (GI) bleeding refers to bleeding that occurs anywhere in the esophagus, the stomach, or the upper part of the small intestine. It is a symptom of an underlying disorder, and it can be serious.
Each year, approximately 100,000 people in the United States go to the hospital because of an upper GI bleed. Severe bleeds can be life threatening and require immediate treatment.
In this article, we look more closely at upper GI bleeds, including their causes and the treatment options.
Upper GI bleeds occur when part of the upper digestive tract becomes injured or inflamed.
A GI bleed is a symptom of another disorder rather than a health condition in itself. Doctors divide GI bleeds into upper and lower bleeds depending on the source of the blood.
Upper GI bleeds can occur in the:
- duodenum, the initial part of the small intestine
Lower GI bleeds can occur in the:
- lower part of the small intestine
GI bleeds can be acute or chronic. Acute bleeds are sudden and severe, while chronic bleeding lasts for a longer period and is typically less obvious. Both can cause serious health complications if a person does not receive treatment.
The location of a GI bleed and the rate of bleeding influence the type of symptoms a person may experience.
The symptoms of a GI bleed can include:
- black, tarry stool
- vomit that is bright red or resembles coffee grounds
- stomach cramps
- unusually pale skin
- feeling faint, dizzy, or tired
People can also experience occult bleeding, which occurs when there is blood in the stool that is not visible. Doctors can detect this blood using a stool test.
Acute GI bleeding can quickly become serious. If a person suddenly develops symptoms of a GI bleed, they should seek immediate medical help.
Acute GI bleeds can also lead to shock, which is a medical emergency. The symptoms include:
If a person has these symptoms, it is important to dial 911 or the number of the nearest emergency department.
Chronic GI bleeding is slower bleeding that can last a long time or may come and go. However, it can still lead to significant health complications, such as anemia.
People with anemia typically feel lightheaded, tired, or short of breath while exercising. They may also look paler than usual.
Anyone who suspects that they may have a chronic GI bleed or anemia should speak with a doctor as soon as possible so that they can get a diagnosis and treatment.
There are many possible causes of upper GI bleeding. These include:
Peptic ulcers are sores that develop on the lining of the stomach and the upper portion of the small intestine. They typically result from a Helicobacter pylori infection or irritation from nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen.
Many people with ulcers experience no symptoms. If symptoms do occur, they may include:
- pain, often in the upper abdomen
- nausea or vomiting
- feeling full or bloated
The symptoms of esophagitis include:
- pain in the chest when swallowing
- difficulty swallowing
- nausea or vomiting
- lack of appetite
- chronic cough
Enteritis occurs when the small intestine becomes inflamed, often due to a bacterial or viral infection. Enteritis can also occur due to radiation therapy, certain medications, alcohol, or inflammatory bowel disease (IBD).
When enteritis is due to an infection, it can cause nausea, vomiting, diarrhea, cramping, and rectal bleeding.
These are tears in the lining of the esophagus that often occur as a result of prolonged vomiting or coughing.
Mallory-Weiss tears can cause a lot of bleeding. Although they sometimes heal on their own, this is not always the case. Some people may require treatment to stop the bleeding and avoid significant blood loss.
People with esophageal varices do not usually have symptoms unless the veins begin to bleed. If these vessels do bleed, they can bleed significantly. The symptoms include:
- stomach pain
- vomiting blood
- bloody stool
Gastritis is inflammation in the stomach. The majority of people with gastritis do not have any symptoms, but it can cause:
- pain in the upper abdomen
- feeling full after eating little
- loss of appetite
- unintentional weight loss
Over time, gastritis can cause ulcers or damage parts of the stomach lining, leading to bleeding. The condition can occur due to NSAID use, injury, IBD, or infection.
Less commonly, cancer is the cause of upper GI bleeding. Some common symptoms of esophageal cancer include:
- difficulty swallowing
- a persistent cough
- vomiting blood
- unexplained weight loss
Cancer can also appear elsewhere along the upper GI tract, where it may also lead to bleeding.
If a doctor suspects that bleeding is responsible for a person’s symptoms, they will take a medical history and perform a physical exam. They may then ask questions about the person’s symptoms, as well as their bowel movements and the color of their stool.
The doctor may also order diagnostic tests or refer the person to a gastroenterologist. A range of tests can help them make a diagnosis, including:
- Stool tests: These can detect inflammation, occult bleeding, or infections, such as H. pylori.
- Blood tests: These tests can reveal anemia.
- Upper endoscopy or enteroscopy: A doctor passes an endoscope down the esophagus to view the stomach or small intestine.
- Gastric lavage: This procedure involves removing the contents of the stomach to determine the source of any bleeding.
- A biopsy: A doctor will take a small sample of tissue from an affected area and send it to a lab for analysis.
- Imaging tests: Examples include CT scans and barium X-rays.
Various factors, including the location, severity, and cause of the bleeding, will determine the treatment options for an upper GI bleed.
For people who visit the emergency department for severe bleeds, the priority is to stop the bleeding. Doctors may do this by:
- injecting a medication directly into the bleeding site
- using heat to treat the bleeding site via a probe or laser
- placing a clip on the blood vessel to seal it shut
Doctors can also use one of these methods while performing diagnostic tests, such as an endoscopy, if they find the location of the bleed.
The next step is to treat the condition responsible for the bleeding. This treatment may involve:
- taking medications to treat underlying conditions, such as antibiotics to clear an H. pylori infection or proton pump inhibitors (PPIs) to suppress stomach acid production and allow ulcers to heal
- stopping any medications or practices that are causing ulceration or bleeding, such as NSAID use
- surgery, which a doctor may recommend if they cannot stop the bleeding in other ways
People who have lost a lot of blood may require intravenous fluids or a blood transfusion.
Many different factors contribute to the conditions that may cause GI bleeds.
If a medication could be worsening ulcers or bleeding, a person should speak with a doctor about alternatives or changes to the dosage. However, it is important never to change the dosage without consulting a medical professional.
A doctor can help someone understand the root cause of a GI bleed and how to treat or manage it. This approach is usually the best way to prevent further bleeds.
People with a history of GI bleeds or ulcers can lower their risk of GI bleeding by:
- avoiding alcohol
- stopping smoking, if a smoker, or avoiding secondhand smoke
- limiting or stopping the use of NSAIDs
People with GERD may also find that certain dietary changes help alleviate their symptoms by reducing irritation and inflammation. People can try avoiding:
- minty, spicy, or acidic foods
- high fat foods
Sudden and severe GI bleeding is a medical emergency, but slower, chronic bleeding can also become serious over time. Anyone who suspects that they have a GI bleed should see a doctor right away.
Doctors can stop or control upper GI bleeding with medications or use heat or surgery to seal wounds. Treating the underlying condition can then prevent further bleeding.