GI Bleeding

The gastrointestinal (GI) tract in humans is an almost unbelievably long organ system averaging, in humans, thirty feet. It includes the mouth, throat, esophagus, stomach, small intestine, large intestine (the colon), rectum, and anus. Along with the liver, pancreas, and gall bladder, it controls all the digestive functions necessary for life. When the organ system malfunctions, a person might experience GI bleeding.

Bleeding from the GI tract can be microscopic, but it can also be severe enough to be life-threatening;  it’s a cause for concern. Knowing how the system works and understanding the symptoms, causes, and treatments of GI bleeding is critical for the family medic.

PARTS OF THE GI TRACT AND THEIR FUNCTION

Each of the parts of the GI tract has a purpose:

The mouth: Begins the digestion process of food with both mechanical breakdown (chewing) and chemical breakdown (saliva with enzymes).

The pharynx: A passage for food (and air) that connects the mouth and nasal cavity to the esophagus and larynx (windpipe).

The esophagus: A tube that shuttles food from the pharynx to the stomach using muscular contractions called “peristalsis.”

The stomach: A temporary storage unit for food where acidic juices initiate protein digestion.

The small intestine: Includes sections called the duodenum, jejunum, and ileum. The small intestine breaks down and absorbs most nutrients, transporting the remaining undigested matter to the large intestine.

The large intestine: Comprised of the cecum and colon, it absorbs water and electrolytes and forms feces.

The rectum: Stores feces before they are expelled through the anus.

The anus: The opening through which feces are expelled.

SYMPTOMS OF UPPER GASTROINTESTINAL BLEEDING

GI bleeding is classified into “upper” and “lower.” The divide occurs in the small intestine, between the duodenum and jejunum. The distinction is important because each type has different features.

The areas involved most often in upper GI bleeding are the esophagus, stomach, and duodenum. The bleeding may exit through the mouth or be evident in bowel movements. Common symptoms include:

Vomiting blood: The blood may appear bright red if fresh. If the blood has been partially digested, it will be brown and resemble coffee grounds.

Black, tarlike stool: Also known as “melena,” it is the appearance of upper GI bleeding that passed through the GI tract and exited through the anus.

Regardless of the point of exit, upper GI bleeding often results in weakness, fatigue, and pallor. This is related to the loss of red blood cells, a condition called “anemia.” Abdominal pain is also seen in many cases, especially if caused by stomach ulcers or other inflammation.

SYMPTOMS OF LOWER GI BLEEDING SYMPTOMS

Lower GI bleeding originates from parts of the small intestine, colon, rectum, or anus. Symptoms include:

Bright or dark red blood in bowel movements, also known as “hematochezia.” This type of bleeding is most often related to the colon or rectum.

Abdominal cramping, diarrhea, or constipation may or may not accompany the bleeding, depending on the cause. Significant loss of blood may result in symptoms of anemia as described above. Low blood pressure and rapid heart rate are seen in severe cases.

CAUSES OF UPPER GASTROINTESTINAL BLEEDING

A wide range of conditions can lead to bleeding anywhere along the GI tract. Some common origins include:

• Peptic ulcer disease: The most common cause of upper GI bleeds. Ulcers in the stomach or duodenum can erode the lining and penetrate blood vessels. Chronic nonsteroidal anti-inflammatory drug (NSAID) use and major stress may also be responsible. Infection with the bacterium Pylori is another proven factor.
• Esophageal varices: Varices are dilated veins, similar to what you might see in the lower legs of older people. When found in the esophagus, it’s usually due to liver damage from excessive alcohol use. Erosion of the lining can lead to bleeding in this area.
• Mallory-Weiss syndrome: Tears at the border of the esophagus with the stomach caused by excessive vomiting may result in upper GI bleeding.

CAUSES OF LOWER GASTROINTESTINAL BLEEDING

• Diverticulosis: Diverticulosis is a condition where there are outpouchings in the lower intestine. If these become inflamed and bleed, it’s known as diverticulitis (mostly seen in older adults).
• Inflammatory Bowel Disease (IBD): Inflammation of the wall of the intestines can lead to erosion and bleeding. Examples include Crohn’s disease and ulcerative colitis.
• Hemorrhoids: Swollen veins in the rectum and anus can cause local pain and bright red bleeding.
• Colitis: Inflammation of the large intestine can lead to the formation of abnormal blood vessels or loss of blood supply to certain areas. Either of these issues can result in lower GI bleeding.
• Polyps: Growths on the intestinal wall that can be benign or cancerous.

Of course, cancer can occur in any part of the GI tract, just as it can most anywhere in the body. Bleeding is a common symptom.

Certain medications, like aspirin, NSAIDs, and blood thinners can increase the risk of hemorrhage by causing inflammation or inhibiting normal clotting.

Foreign bodies and blood clotting disorders should be included as possible causes.

DIAGNOSIS AND TREATMENT

Sometimes, bleeding is so obvious that there is no doubt. In other circumstances, blood loss is microscopic and only seen with special fecal testing. One of these is Cologuard, which detects altered DNA and human blood in bowel movements. Another is the Fecal immunochemical test (FIT), which identifies microscopic human blood in the stool. A third is the older Hemoccult II Sensa test, which identifies microscopic blood as well, but cannot distinguish between human and animal blood (from eating red meat) or can falsely turn positive from eating certain foods like beets, taking aspirin, or using iron supplements.

Depending on the type of bleeding and test results, two diagnostic tests might be recommended that may also serve as treatment:

• Esophagogastroduodenoscopy (EGD), also called upper endoscopy. This procedure allows direct visualization and is used for upper GI bleeding to identify and treat bleeding sites. Techniques include injection of epinephrine, thermal coagulation, or clipping to stop bleeding.
• Colonoscopy: For lower GI bleeding, colonoscopy can identify and treat sources like diverticula or polyps using the techniques used in upper endoscopy.

More invasive procedures may include removal of the bleeding portion of the GI tract if not treatable by colonoscopy or upper endoscopy.

It should be noted that H. pylori infections, a major cause of upper GI ulcers, can be treated with a combination of antibiotics like amoxicillin, metronidazole, clarithromycin, or tetracycline. Usually, an acid reducer such as omeprazole is added. A home test can identify the presence of the bacterium.

Further treatment of GI bleeding depends on its cause, location, and severity. Management of the problem involves stabilizing the patient, identifying the bleeding source, and monitoring heart rate and blood pressure.

DIETARY AND LIFESTYLE CHANGES

Limited natural options are available to treat significant bleeding, but you can consider focusing on easily digestible foods: Soft fruits (apples, pears, papayas) and easily digestible vegetables are relatively gentle on the digestive tract. Foods that absorb stomach acid, like bread, can help absorb and reduce stomach acid, preventing ulcers.

Replacement of lost blood cells is important. Food that are rich in iron can help: Options include red meat, shellfish, poultry, eggs, beans, raisins, whole-grain breads, and leafy green vegetables.

Many people have “trigger” foods that lead to inflammation that causes bleeding. These vary among individual and include dairy, spicy foods, and refined sugar.  Alcohol can also irritate the digestive tract.

Consider adding fiber to the diet. Increasing fiber intake can help prevent constipation, which can worsen bleeding from polyps or hemorrhoids.

Certain changes in lifestyle can also make a difference. They include:

• Limiting alcohol and smoking: These can irritate the digestive tract and increase the risk of bleeding.
• Managing stress: Stress can contribute to GI issues. Practice relaxation techniques like deep breathing or meditation.
• Avoiding certain medications that Increase bleeding risk: If possible, avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin unless necessary, as they can increase bleeding risk.
• Treating underlying conditions: Address factors that contribute to bleeding, like acid reflux, diverticulitis, and hemorrhoids.

Home remedies are limited, but exist for conditions such as hemorrhoids:

• Warm baths can help soothe pain and reduce inflammation.
• Creams/ointments can help relieve itching and discomfort.
• Ice packs can help reduce anal swelling and pain.

Unfortunately, GI bleeding off the grid can be difficult to handle; it’s another of the medical issues that are hard realities in times of trouble and present serious challenges to the survival medic.

Joe Alton MD