GI Bleed

Have you noticed blood in vomit or blackish stools?

GI bleed, or gastrointestinal bleed, is basically bleeding from the digestive system, and it is never something to wait out. It can be sudden and heavy, or slow and silent, and in both cases, it leads to blood-stained stools or vomit along with a sudden drop in haemoglobin.

Every GI bleed ultimately comes from a blood vessel and is mostly managed with medication or endoscopy. When that doesn’t work or the bleed it out of reach, a vascular specialist should step in.

Read on to learn what causes GI bleeding and how it is treated.

What Is a GI Bleed?

A gastrointestinal (GI) bleed is bleeding from any part of the digestive tract, from the food pipe and stomach to the intestines, colon, rectum or anus.

Based on where the bleeding starts, it can be of 2 types:

Upper GI bleed, which comes from the food pipe, stomach or first part of the small intestine (duodenum).
Lower GI bleed comes from the rest of the small intestine, colon, rectum or anus.

Upper bleeds are more common and usually more serious because blood loss can be rapid.

GI Bleed starts when a blood vessel in the gut wall erodes, ruptures or is abnormally fragile or swollen. The cause may be an ulcer, a tumour or inflamed tissue.

GI Bleed Symptoms

Symptoms depend on the cause, how fast the bleeding is, and how much you are bleeding.

Vomiting Blood

Bright red blood, or dark material that looks like coffee grounds in your vomit, indicates an upper GI bleed.

Blood in Stools

Bright red or maroon blood in the stools comes from the rectum or anus, or slightly higher areas in the lower gut.

Sticky, dark-coloured stools (melaena) usually suggest bleeding higher up in the tract.

Dizziness

Light-headedness, a racing heartbeat, cold clammy skin or collapse can signal rapid and significant blood loss.

Tiredness & Pallor

Slow, hidden bleeding shows as unexplained tiredness, pale skin, weakness, breathlessness and low haemoglobin.

Abdominal Pain

Burning or cramping pain, bloating, or fullness can accompany the bleed.

If you vomit blood, pass black or bloody stools, or feel faint, go to the nearest emergency department immediately.

GI Bleed Causes

GI bleeding signals an underlying problem. The cause depends on where the bleeding is coming from.

Upper GI Bleed

Peptic Ulcers

Open sores in the stomach or duodenum, often linked to H. pylori infection or regular painkiller use, are the most common cause of upper GI bleeding.

Painkillers (NSAIDs)

Diclofenac, ibuprofen and aspirin weaken the stomach’s protective lining, especially with long-term or unsupervised use.

Oesophageal and Gastric Varices

Swollen veins in the food pipe or stomach are caused by raised pressure, as in liver disease. These can bleed heavily and suddenly.

Gastritis and Erosions

Inflammation of the stomach lining from alcohol, medicines, cancers or severe illness.

Lower GI Bleed

Piles and Anal Fissures

A common cause of fresh red blood in the stool, and usually less serious.

Diverticular Disease

Small pouches in the colon wall that can bleed painlessly and sometimes heavily.

Angiodysplasia

Fragile, abnormal blood vessels in the gut wall, more common with advancing age.

Polyps and Tumours

Small growths in the stomach, colon or rectum that can bleed slowly or suddenly.

Blood Thinners

Anticoagulant and antiplatelet medicines do not cause the bleed themselves, but can make an existing one heavier and harder to stop.

GI Bleed Diagnosis

The first priority is to stabilise you. Then the team works to find exactly where the bleeding is coming from and why.

Clinical Exam and Blood Tests

Fast pulse and low blood pressure, often with a drop in BP on standing
Low haemoglobin
Raised blood urea, often seen in upper GI bleeds
Prolonged clotting time (raised INR) in liver disease or with blood thinners
Black stool or fresh blood on rectal examination

Upper GI Endoscopy

A thin camera is passed through the mouth to examine the food pipe, stomach and duodenum.

It is the first test for upper bleeds and can often treat the source at the same time.

Ulcer with an exposed vessel, active oozing or a clot
Varices (swollen veins) with red marks or active bleeding
Gastritis, erosions, or a growth in the food pipe or stomach

CT Angiography

A rapid scan that uses contrast dye to show where blood is leaking from a vessel.

It is especially useful when endoscopy cannot find the source or the bleeding is too heavy to see clearly.

Contrast leaking into the bowel, which confirms active bleeding and shows its site
The artery feeding the bleed
Underlying cause, such as a growth, diverticula or an abnormal vessel

Catheter Angiography

An X-ray study done by injecting dye through a small puncture at the wrist or groin. This pinpoints the bleeding vessel, and it can be treated in the same sitting. Contrast leaking from the bleeding vessel Abnormal tangled vessels in angiodysplasia A pseudoaneurysm (weakened, bulging vessel wall)

GI Bleed: Treatment

Treatment depends on the cause, site, and severity of the bleeding.

Emergency stabilisation is the first step, and endoscopy with clips, heat therapy, injection therapy or ligation applied directly at the bleeding site helps control most bleeds.

When these efforts fail, vascular surgeons employ the following procedures to control the bleeding

Angiographic Embolisation

When bleeding continues after endoscopy, keeps returning, or the source cannot be reached, the bleeding vessel is blocked from the inside through a thin catheter, using coils, particles or medical glue.

It is done through a small puncture at the wrist or groin, with no large incision, and is often the preferred alternative to emergency surgery, especially in patients too unwell for a major operation.

Stent Grafts and Repair of Bleeding Vessels

Some GI bleeds come from a damaged artery rather than the gut lining, and need the vessel itself repaired.

Pseudoaneurysm: A weakened, bulging wall of an artery near the stomach, pancreas or liver (often after pancreatitis or surgery) that ruptures into the gut may be treated with coiling or a covered stent.
Aortoenteric fistula: an abnormal link between the aorta and the bowel, either from an aortic aneurysm or after previous aortic surgery. An endovascular stent graft (EVAR) can stop the bleeding as a life-saving measure.

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

For bleeding venous clusters (varices) in liver disease that are uncontrolled or keep returning, TIPS may be recommended.

TIPS (transjugular intrahepatic portosystemic shunt) is a channel placed inside the liver to lower the pressure in the bleeding veins

GI Bleed Results: Before & After

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Gi Bleed