Gastrointestinal bleeding

Gastrointestinal bleeding
Other names	Gastrointestinal hemorrhage, GI bleed
A positive fecal occult blood test
Specialty	Gastroenterology
Symptoms	Vomiting red blood, vomiting black blood, bloody stool, black stool, fatigue[1]
Complications	Iron-deficiency anemia, heart-related chest pain[1]
Types	Upper gastrointestinal bleeding, lower gastrointestinal bleeding[2]
Causes	Upper: peptic ulcer disease, esophageal varices due to liver cirrhosis, cancer[3] Lower: hemorrhoids, cancer, inflammatory bowel disease[2]
Diagnostic method	Medical history and physical examination, blood tests[1]
Treatment	Intravenous fluids, blood transfusions, endoscopy[4][5]
Medication	Proton pump inhibitors, octreotide, antibiotics[5][6]
Prognosis	~15% risk of death[1][7]
Frequency	Upper: 100 per 100,000 adults per year[8] Lower: 25 per 100,000 per year[2]

Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum.^[9] When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.^[1] Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain.^[1] Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out.^[1][9] Sometimes in those with small amounts of bleeding no symptoms may be present.^[1]

Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding.^[2] Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others.^[3] Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.^[2][1] Small amounts of bleeding may be detected by fecal occult blood test.^[1] Endoscopy of the lower and upper gastrointestinal tract may locate the area of bleeding.^[1] Medical imaging may be useful in cases that are not clear.^[1] Bleeding may also be diagnosed and treated during minimally invasive angiography procedures such as hemorrhoidal artery embolization.^[10][11]

Initial treatment focuses on resuscitation which may include intravenous fluids and blood transfusions.^[4] Often blood transfusions are not recommended unless the hemoglobin is less than 70 or 80 g/L.^[7][12] Treatment with proton pump inhibitors, octreotide, and antibiotics may be considered in certain cases.^[5][6][13] If other measures are not effective, an esophageal balloon may be attempted in those with presumed esophageal varices.^[2] Endoscopy of the esophagus, stomach, and duodenum or endoscopy of the large bowel are generally recommended within 24 hours and may allow treatment as well as diagnosis.^[4]

An upper GI bleed is more common than lower GI bleed.^[2] An upper GI bleed occurs in 50 to 150 per 100,000 adults per year.^[8] A lower GI bleed is estimated to occur in 20 to 30 per 100,000 per year.^[2] It results in about 300,000 hospital admissions a year in the United States.^[1] Risk of death from a GI bleed is between 5% and 30%.^[1][7] Risk of bleeding is more common in males and increases with age.^[2]