Gastrointestinal Bleeding
gastrointestinal bleeding

A potentially life threatening bleeding phenomena observed anywhere in the Gastrointestinal tract.

Where do gastrointestinal bleeding (GIB) episodes occur?

  • 70 to 75% in the upper GI tract
    • Oesophagus, stomach, duodenum, biliary/pancreatic systems.
  • 25 to 30% in the lower GI tract
    • Jejunum and ileum, colon, anus

What are the symptoms?

Divided into 2 parts i.e; Upper Gastro intestinal Bleeding and Lower Gastro Intestinal Bleeding

LG1

  • Vomiting blood – Hematemesis
  • Bloody stool or Rectal Bleeding
  • Dizziness
  • Fainting
  • Fatigue & Weakness
  • Paleness
  • Shortness of breath or difficulty breathing
  • Little or no urine
  • Low blood pressure
  • Rapid heart beat

LG2

  • Peptic ulcer Disease
  • Drug induced bleeding
  • Liver cirrhosis
  • Esophagitis
  • Gastritis
  • Diverticular disease
  • Haemorrhoids or anal fissures
  • Inflammatory bowel disease
  • Large intestine problems – Colitis
  • Enlarged veins in the oesophagus – Oesophageal varices

What causes Gastrointestinal Bleeding?

  • Benign tumours and cancer
  • Bleeding of enlarged blood vessels in the stomach – Angiodysplasia
  • Colon polyps
  • Esophagitis
  • Gastritis
  • Peptic Ulcers
  • Mallory-Weiss tears

What are the complications?

  • Anemia
  • Shock
  • Confusion
  • Death

How Gastrointestinal Bleeding is diagnosed?

  • Symptom analysis & Differential Diagnosis
  • Lab Tests – Complete Blood Profile, FOBT, Stool Test, H. pylori tests, Electrolyte test, Coagulation time, Creatinine and BUN
  • Esophagogastroduodenoscopy (EGD)
  • Colonoscopy
  • Capsule Endoscopy
  • Flexible sigmoidoscopy
  • Balloon-assisted enteroscopy
  • Imaging –Doppler Ultrasound, MRI, MR or CT Angiography, Nuclear scintigraphy if needed

Treatment of the cause:

  • Blood Transfusion rarely
  • Platelets and fresh frozen plasma (FFP) transfusion
  • Intravenous (IV) fluid resuscitation

How Gastrointestinal Bleeding is treated?

  • Medication – Proton Pump Inhibitors, Broad Spectrum Antibiotics, Histamine receptor blocking agents (H2RA), gastric mucosa-protecting agent, Antihypertensive meds, Somatostatin mimic, nonselective β-blockers
  • Surgical Treatments – Vagotomy, Pyloroplasty, Partial gastrectomy, Vasoconstrictive Therapy, Emergent Surgery
  • Superselective Embolization
  • Therapeutic Endoscopy – Early endoscopy, Urgent endoscopy,
    • Techniques – Photocoagulation, Electrocoagulation, bipolar probe coagulation, Sclerotherapy, Radiological Therapy, Endoscopic hemoclips, Injections, Plasma coagulation, Application of powder/spray, endoscopic variceal ligation, Endoscopic band ligation (EBL)
  • Post endoscopy monitoring

How to prevent Gastrointestinal Bleeding?

Usually depends on the cause which may need precaution or specific treatment

  • Stop using over the counter meds like Aspirin and NSAIDs
  • Consult doctor and a dietician for self-care tips, diet, medications and supplements
  • Eat fibre rich foods
  • Avoid or quit alcohol and smoking
  • Patients suffering from peptic ulcer disease should be tested regularly and treated for Helicobacter pylori infection
  • Patients with a history of bleeding ulcers who need long-term treatment with aspirin or a nonsteroidal anti-inflammatory drug should also be prescribed a proton pump inhibitor

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