A gastrointestinal (GI) bleed is a loss of blood occurring anywhere along the digestive tract, which runs from the esophagus to the rectum. A GI bleed can be fatal, though the risk depends highly on the speed and volume of blood loss. While many bleeds are minor and resolve naturally or with simple treatment, an acute, massive hemorrhage is a medical emergency that can quickly become life-threatening.
Understanding Gastrointestinal Bleeding
Gastrointestinal bleeding is categorized by its location relative to the ligament of Treitz, which divides the upper and lower digestive tracts. Upper GI bleeding originates in the esophagus, stomach, or duodenum. This type is statistically more common and often carries a higher rate of severe complications.
Common causes of upper GI bleeds include peptic ulcers (erosions in the stomach or duodenum lining) and esophageal varices (enlarged veins often seen with advanced liver disease). Lower GI bleeding occurs below the ligament of Treitz, typically in the small intestine, colon, rectum, or anus. Causes for lower bleeds frequently involve diverticulosis, hemorrhoids, and inflammatory conditions like colitis.
Factors Determining Severity and Risk of Death
Fatality from a GI bleed is primarily caused by hypovolemic shock, which occurs when the body loses a substantial amount of blood volume rapidly. When the heart can no longer pump enough blood to supply oxygen to the body’s tissues, inadequate circulation leads to cellular hypoxia and, if untreated, multiple organ failure and death.
The speed of the bleeding is important, as a sudden, massive hemorrhage triggers this physiological cascade more quickly than chronic, slow blood loss. Underlying patient health also significantly influences the risk of death. Advanced age, existing heart or kidney disease, and severe liver conditions (like cirrhosis) reduce the body’s ability to withstand and recover. Patients taking blood-thinning medications or nonsteroidal anti-inflammatory drugs (NSAIDs) face an increased risk due to impaired clotting and potential ulcer formation.
Recognising the Warning Signs
The visible signs of a GI bleed depend on the location and rate of blood loss. An upper GI bleed often presents as hematemesis (vomiting blood). This blood may be bright red if the bleeding is active, or it may look like dark “coffee grounds” if partially digested by stomach acid.
Another sign of an upper bleed is melena, which refers to black, tarry, and foul-smelling stools. The black color results from hemoglobin being chemically altered by digestive enzymes as it passes through the intestines. In contrast, a lower GI bleed typically causes hematochezia, the passage of bright red blood from the rectum, sometimes mixed with stool.
Systemic signs of severe blood loss, indicating progression toward shock, include dizziness or fainting, a rapid heart rate, confusion, and pale, clammy skin. These signs necessitate immediate emergency medical attention.
Medical Intervention and Stopping the Bleeding
Initial medical management focuses on stabilizing the patient and counteracting the effects of blood loss. This often involves immediate administration of intravenous fluids and, in cases of significant volume loss, blood transfusions to restore circulating volume and oxygen-carrying capacity. Medications like proton pump inhibitors (PPIs) are commonly used to suppress stomach acid, which can help stabilize an upper GI bleed.
Once the patient is stable, the source of the bleeding is identified, typically through an upper endoscopy or a colonoscopy. These procedures use a flexible tube with a camera to visualize the digestive tract and can also be used therapeutically. During the procedure, the physician can stop the bleeding by applying small metal clips, injecting medications to constrict the vessel, or using heat (cauterization) to seal the bleeding point. In rare instances, surgical intervention may be required to access and repair the vessel.