Are you experiencing intense abdominal pain and noticing the presence of blood in your stools? In this article, we will explore the causes, symptoms, and essential treatments for gastrointestinal bleeding.
This is a medical condition that can cause concern and often requires immediate attention. Characterized by the presence of bleeding in any part of the digestive tract, this condition can manifest in various ways, from visible blood in the stools to more subtle symptoms such as abdominal pain and fatigue.
What is gastrointestinal bleeding?
This condition refers to bleeding that occurs in any part of the digestive system, which includes organs such as the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus.
This bleeding can be acute, occurring suddenly and in large amounts, or chronic, developing slowly over time and often going unnoticed until symptoms become severe.
Bleeding can be classified as upper, when it occurs in the esophagus, stomach, or duodenum, or lower, when it occurs in the small intestine, colon, rectum, or anus.
Common causes of gastrointestinal bleeding
There are several possible causes, and accurate identification of the cause is crucial for proper treatment.
Peptic ulcers
Injuries that develop in the inner lining of the stomach (mucosa) or the upper part of the small intestine.
The two most common causes are infection caused by the bacterium Helicobacter pylori and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.
Esophageal varices
Dilated veins in the esophagus that can rupture and bleed, often associated with cirrhosis of the liver. Cirrhosis can cause increased pressure in the veins of the esophagus, leading to the formation of varices.
Diverticulosis
Small pouches formed in the wall of the colon, known as diverticula, which can become inflamed or rupture local vessels, causing bleeding. This condition is more common in elderly people.
Inflammatory bowel disease (IBD)
Conditions such as Crohn’s disease and ulcerative colitis, which cause chronic inflammation of the digestive tract, can lead to erosions and ulcers that bleed.
Gastrointestinal cancer
Malignant tumors in the stomach, colon, or rectum that can cause bleeding. The presence of blood in the stools can be one of the first signs of gastrointestinal cancer.
Gastritis
Inflammation of the lining of the stomach, which can be caused by infections, use of NSAIDs, alcohol, or stress. Erosive gastritis can lead to the development of bleeding.
Angiodysplasia
Malformations of the blood vessels in the gastrointestinal tract, which can rupture and cause bleeding.
Esophagitis
Inflammation of the esophagus, often caused by acid reflux, can lead to erosions and ulcers that bleed.
Hemorrhoids
Dilated veins in the anus or rectum, which can bleed, especially during bowel movements. Although hemorrhoids usually cause mild bleeding, in some cases, they can lead to more significant bleeding.
Anal fissures
Small tears in the lining of the anus, usually caused by hard bowel movements or constipation, which can cause bleeding.
In addition to these causes, other conditions and risk factors can contribute to bleeding, such as excessive alcohol use, smoking, a diet low in fiber, and a family history of gastrointestinal diseases.
Symptoms of gastrointestinal bleeding
Symptoms can vary widely depending on the location and severity of the bleeding, and early identification of these signs is essential for effective treatment.
One of the most evident symptoms is the presence of blood in the stools, which can manifest in different forms.
Dark, almost black stools (known as melena) usually indicate bleeding in the upper gastrointestinal tract, such as in the stomach or duodenum.
Stools with bright red blood suggest bleeding in the lower gastrointestinal tract, such as in the colon or rectum. This differentiation is important for directing diagnosis and treatment.
Another significant symptom is vomiting with blood, which can appear with a coffee-ground appearance, indicating that the blood has been partially digested, or as bright red blood, suggesting more active bleeding in the esophagus, stomach, or duodenum.
The presence of vomiting with blood is an alarming sign and requires immediate medical evaluation.
Beyond pain, bleeding can cause a feeling of fullness or bloating, especially if the bleeding is located in the upper gastrointestinal tract.
Anemia resulting from this blood loss can cause extreme fatigue, difficulty performing daily activities, and a general feeling of exhaustion.
These symptoms are exacerbated by the decreased ability of the blood to carry oxygen to the body’s tissues.
Dizziness or fainting are critical symptoms that can occur, especially in cases of significant blood loss.
Such symptoms are caused by the decrease in blood volume and low blood pressure, which can result in inadequate perfusion of vital organs.
In more severe cases, the patient may present symptoms of hypovolemic shock, a medical emergency condition.
Signs of shock include mental confusion, cold and clammy skin, rapid and shallow breathing, and a weak and rapid pulse.
Patients with inflammatory bowel disease may have episodes of chronic diarrhea and recurrent abdominal pain, while those with cirrhosis of the liver may have signs of liver failure, such as jaundice and ascites.
Diagnosis of gastrointestinal bleeding
The most common methods include endoscopy, which is a procedure that involves the insertion of a flexible tube with a camera (endoscope) through the esophagus, stomach, and small intestine to view and identify the source of the bleeding.
Endoscopy allows the doctor to directly examine the lining of the upper digestive tract and perform biopsies if necessary.
Another similar procedure is colonoscopy, in which the endoscope is inserted through the rectum to examine the colon. Colonoscopy is used to detect polyps, cancer, and other abnormalities in the colon.
Blood tests are performed to check for anemia and other indicators of blood loss, such as hemoglobin levels, hematocrit, and platelet count.
Computed tomography (CT) is another method used to visualize the digestive tract and detect abnormalities. CT can be particularly useful for identifying causes of bleeding in the small intestine.
Stool tests, such as the fecal occult blood test (FOBT), are used to detect hidden blood in the stools, which may not be visible to the naked eye.
Angiography is an imaging procedure that uses a contrast dye to visualize blood vessels and identify the location of bleeding, often used in cases of active and significant bleeding.
Another test, scintigraphy with labeled red blood cells, involves labeling red blood cells with a radioisotope and visualizing their movement through the gastrointestinal tract to locate the source of bleeding.
Essential treatments for gastrointestinal bleeding
Medications such as antacids, proton pump inhibitors (PPIs), and antibiotics are used to treat ulcers and infections.
Therapeutic endoscopy allows cauterizing, clipping, or injecting medications into the bleeding area, while techniques such as elastic ligation treat esophageal varices.
In severe cases, surgery may be necessary to remove affected parts of the digestive tract. Blood transfusions help stabilize hemoglobin levels and treat anemia.
Specific therapies, such as elastic ligation or sclerotherapy, control esophageal varices, and the transjugular intrahepatic portosystemic shunt (TIPS) can reduce pressure in the esophageal veins.
Intravenous fluid replacement and medications stabilize vital signs. Intravenous nutrition is used in severe and prolonged bleeding.
Radiological procedures, such as embolization of blood vessels, control bleeding in cases of vascular malformations.
Continued care includes dietary changes, cessation of NSAIDs, and follow-up with a gastroenterologist.
Gastrointestinal bleeding is a serious medical condition that requires rapid diagnosis and effective treatment. Understanding its causes, recognizing the symptoms, and seeking appropriate medical care are essential steps to ensure the health and well-being of the patient.
If you are experiencing symptoms of gastrointestinal bleeding, do not hesitate to seek medical help immediately. Proper management can prevent serious complications and significantly improve the patient’s prognosis.
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Doutor em Gastroenterologia pela FM-USP.
Especialista em Cirurgia do Aparelho Digestivo (HCFMUSP), Endoscopia Digestiva (SOBED) e Gastroenterologia (FBG).
Professor do curso de Medicina da Fundação Educacional do Município de Assis - FEMA.
Médico da clínica Gastrosaúde de Marília.