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Chronic Gastrointestinal Bleeding

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Introduction

Gastrointestinal Bleeding (GI bleed), also known as gastrointestinal haemorrhage (GIB), refers to all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. There is significant blood loss in a short span.

The digestive tract consists of the esophagus, stomach, small intestine, including duodenum, large intestine or colon, rectum, and anus. Gastrointestinal Bleeding can occur in any of these organs. If bleeding occurs in the esophagus, stomach, or initial part of the small intestine (duodenum), it is called upper GI bleeding. Bleeding in the lower part of the small intestine, large intestine, rectum, or anus is called lower GI bleeding.

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What Causes Chronic Gastrointestinal Bleeding?

Different parts of the digestive tract are affected by specific conditions. There are various causes of bleeding in different regions.

Causes of upper Gastrointestinal Bleeding

  • ● Peptic ulcers are a common cause of GI bleeding. These ulcers are open sores that develop in the lining of the stomach or duodenum. An infection from Helicobacter pylori bacteria usually causes peptic ulcers.
  • ● Enlarged veins in the esophagus can tear and bleed as a result of a condition called esophageal varices. Tears in the walls of the esophagus can also cause GI bleeding. This condition is known as the Mallory-Weiss syndrome.

Causes of lower Gastrointestinal Bleeding

  • One of the most common causes of lower GI bleeding is colitis, which occurs when the colon becomes inflamed. Colitis has multiple causes, including:
  1. Infection
  2. Food poisoning
  3. Parasites
  4. Crohn’s disease or ulcerative colitis
  5. Reduced blood flow to the colon
  6. Haemorrhoids are another common cause of GI or rectal bleeding. A haemorrhoid is an enlarged vein in the rectum or anus. These enlarged veins can rupture and bleed, causing rectal bleeding
  7. An anal fissure, usually caused by constipation or hard stools, may also cause lower GI bleeding. A fissure is a tear in the muscular ring that forms the anal sphincter

What Are the Symptoms of Chronic Gastrointestinal Bleeding?

Chronic Gastrointestinal Bleeding can cause anaemia. Some of the common symptoms of Gastrointestinal Bleeding include:

  • ● Fatigue, loss of energy.
  • ● Weakness
  • ● Dizziness or lightheadedness.
  • ● Pale skin.
  • ● Shortness of breath, especially when exercising.
  • ● Difficulty concentrating.
  • ● Palpitations – feeling that the heart is racing or beating irregularly.
  • ● Chest pain.
  • ● Cold hands and feet.
  • ● Headache
  • ● Blood pressure drop.
  • ● Unconsciousness
  • ● Little or no urination.
  • ● Abdominal pain or cramping.
  • ● Rectal bleeding or blood in stools.
  • ● Abdominal swelling.

How is Chronic Gastrointestinal Bleeding Diagnosed?

Diagnosis of Chronic Gastrointestinal Bleeding involves analysing any medical history of bleeding, testing blood samples, and conducting physical and other exams. Some of the most common diagnostic methods include:

  • Lab tests: Tests such as complete blood count (CBC), serum chemistries, liver tests, and coagulation studies can determine the rate or severity of bleeding and identify the factors that may contribute to the problem.
  • Stool test: Involves the analysis of stool samples. A stool test can help in the diagnosis of occult bleeding.
  • Blood test: It can help determine the extent of bleeding and severity of anaemia.
  • Gastric lavage: It is a procedure in which a doctor passes a tube through the nose or mouth into the stomach to remove the stomach contents to determine the possible location of a GI bleed. Liquid anesthesia is often used to numb the throat during this procedure.
  • Endoscopy: The procedure involves examining a hollow passage in the body using a special instrument called an endoscope. An endoscopy may help the doctor analyze an internal GI bleed and its cause. Often, upper GI endoscopy and colonoscopy are used to test for acute GI bleeding in the upper and lower GI tracts.
  • Colonoscopy: A colonoscopy is a procedure in which a long, flexible, narrow tube with a light and tiny camera on one end called the colonoscope or scope is used to examine the inner rectum and colon. A trained specialist performs the colonoscopy procedure; sedatives, anesthesia, or pain medicine are often used with this procedure.
  • Imaging test: A variety of other imaging tests, such as an abdominal CT scan, might be used to find the source of the bleed.

How is Chronic Gastrointestinal Bleeding Treated?

Treatment of Chronic Gastrointestinal Bleeding is often based on the severity of the bleed and its location. But in most minor cases, the gastrointestinal bleed resolves on its own with or without medication.

  • Peptic ulcer: If a peptic ulcer is the cause of GI bleeding, the following treatment procedures are followed.
  • Proton Pump Inhibitors: Medications that reduce stomach acid production are used in severe cases to reduce mortality and recurrence of internal bleeding.
  • Endoscopy: An endoscopy can be useful not only in diagnosis but also in treating gastrointestinal bleeding.
  • Variceal bleeding: Variceal bleeding develops when pressures in the portal venous system increase, called portal hypertension. Blood leaks may be seen in vomit or bowel motion.
  • Somatostatin, octreotide: Growth hormone inhibitors are often recommended to treat variceal bleeding.
  • ● Haemorrhoids and anal fissures may be treated with a fiber-rich diet, fluids to keep stools soft, and stool softeners if necessary. If they do not heal, the patient may need surgery to remove or fix them.
  • ● If a large amount of blood is found in the upper GI tract, patients may be given prokinetics (medication to empty the stomach), such as erythromycin or metoclopramide.
  • ● Other medications may include antibiotics in patients with cirrhosis of the liver.

What is the Results of Chronic Gastrointestinal Bleeding Treatment?

The treatment of Chronic Gastrointestinal Bleeding in most cases is usually successful without any other problems.

What Are the Risk Associated with Chronic Gastrointestinal Bleeding?

Here are certain risks that should be considered before going in for surgery.

  • Infection: A course of antibiotics generally heals it.
  • Bowel incontinence: It refers to involuntary defecation and is a potential risk. Although, it is rare.
  • Recurrence of Gastrointestinal Bleed: GI bleeds, at times, may recur even after surgery.

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FAQ's

What are some Causes of Chronic Gastrointestinal Bleeding?

Haemorrhoids, anal fissures or tears, ulcers, cancer, polyps, inflammation in the GI tract, variceal bleeding, Crohn’s disease, ulcerative colitis, and angiodysplasia are some major causes of Chronic Gastrointestinal Bleeding.

How Serious is a GI Bleed?

GI Bleeding is a symptom of a disorder in the digestive tract. The level of bleeding can range from mild to life-threatening.

What are the Tests Used to Diagnose GI Bleeding?

Endoscopy and colonoscopy are often used to diagnose GI Bleeding.

What is the Complication of GI Bleeding?

Anemia, loss of blood, Haemorrhage, and infections are some complications of GI Bleeding.

What are the Three Types of bleeding?

Arterial, Venous, and Capillary are the three types of Bleeding.

What are some Preventive Measures to avoid a GI Bleed?

Primary preventive measures for upper GI Bleeding include NSAIDs, antiplatelet therapy, and anticoagulants. The secondary preventive measures include testing and long-term use of PPI medication.

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