Gastrointestinal (GI) Bleeding

What is GI bleeding?

Gastrointestinal (GI) bleeding refers to internal bleeding into the digestive tract. It may be visible or hidden (occult), and symptoms vary depending on the location and severity of the bleed. Common signs include:

  • Vomiting blood (which may appear bright red or like coffee grounds)

  • Black, tarry stool (melaena)

  • Passage of fresh red blood with stool

  • Iron deficiency anaemia (often due to occult bleeding)

  • A positive bowel cancer screening test

What are common risk factors for GI bleeding?

  • Increasing age

  • Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants, and antiplatelets

  • Helicobacter pylori (H. pylori) infection

  • Chronic liver disease (e.g. cirrhosis), heart or kidney disease

  • History of previous GI bleeding, peptic ulcers, inflammatory bowel disease (IBD), and certain surgeries

  • Alcohol misuse

What are the common causes of GI bleeding?

Upper GI tract (oesophagus, stomach, duodenum)

  • Severe inflammation (oesophagitis, gastritis, duodenitis)

  • Ulcers (oesophageal, gastric, or duodenal)

  • Varices (enlarged veins in the oesophagus or stomach often related to liver cirrhosis)

  • Mallory-Weiss tears (small tears in the oesophagus, often after vomiting or retching)

  • Vascular malformations (e.g. angioectasia, Dieulafoy lesions, gastric antral vascular ecatasia)

  • Tumours

Small bowel

  • Vascular malformations (e.g. angioectasia, Dieulafoy lesions)

  • Inflammation (e.g. Crohn’s disease or enteritis)

  • Diverticular disease

  • Tumours

Colon and rectum

  • Haemorrhoids

  • Anal fissures

  • Diverticular disease

  • Colitis (inflammatory or infectious)

  • Large polyps or cancers

  • Vascular malformations (e.g. angioectasia, Dieulafoy lesions)

  • Rectal varices

What can be done about GI bleeding?

GI bleeding can often be treated effectively using minimally invasive techniques during an endoscopic procedure. These include:

  • Thermal therapy (applying heat to stop bleeding)

  • Injection therapy (e.g. adrenaline to constrict blood vessels)

  • Mechanical therapy (e.g. clips to apply pressure to bleeding vessels)

  • Topical haemostatic sprays to promote clotting

  • Band ligation, particularly for varices

Medications (such as proton pump inhibitors) are often required in cases of upper GI bleeding. In severe cases where endoscopic therapy is not possible or effective, surgery or an embolisation procedure is required to treat the bleeding. If you take blood-thinning medications, these are usually paused or adjusted until the bleeding is under control.