Gastrointestinal Bleeding

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Gastrointestinal (GI) bleeding is a symptom that indicates an issue within the digestive tract, which extends from the oesophagus to the anus.

It can present visibly or as occult (hidden) blood, requiring specific medical evaluation to locate its source and assess severity. GI bleeding can stem from a range of conditions, including peptic ulcers, gastritis, diverticular disease, and cancer, making prompt diagnosis necessary for effective treatment.

Causes and Risk Factors

GI bleeding arises from various conditions, often classified by their location in the GI tract:

Upper GI Tract
  • Peptic Ulcers: Open sores that develop in the lining of the stomach or duodenum, often caused by Helicobacter pylori infection or frequent use of pain relievers like ibuprofen. These sores can bleed if irritated or untreated.
  • Gastritis: Inflammation of the stomach lining, possibly due to infections, excessive alcohol consumption, stress, or certain medications, which can lead to irritation and bleeding.
  • Oesophageal Varices: Swollen veins in the lower part of the oesophagus, commonly resulting from liver disease. If these veins rupture, they can cause severe bleeding.
Lower GI Tract
  • Diverticular Disease: Small pouches, or diverticula, that form in the walls of the colon, particularly in older adults. These pouches can become inflamed or irritated, leading to bleeding.
  • Colorectal Polyps and Cancer: Abnormal growths in the colon, which may be non-cancerous (polyps) or cancerous. Cancerous growths are more likely to bleed as they grow and affect nearby tissue.
  • Angiodysplasia: Fragile, abnormal blood vessels, often found in the colon and common in older adults, which can bleed spontaneously without causing pain.
  • Inflammatory Bowel Disease (IBD): Chronic inflammation of the intestinal lining, associated with conditions like Crohn’s disease and ulcerative colitis, which increases the risk of bleeding in the affected areas of the intestine.

Diagnosis of Gastrointestinal Bleeding

Diagnosis focuses on identifying the bleeding source and determining the cause. The primary steps include:

Medical History and Physical Exam

The doctor assesses symptoms, medical history, and risk factors. They also check for signs of anaemia, such as pale skin, and may assess abdominal tenderness. A history of conditions like ulcers, liver disease, or prior bleeding episodes can help guide further testing.

Blood Tests

A complete blood count (CBC) assesses haemoglobin levels for signs of anaemia due to blood loss. Additional tests may check liver function or clotting factors if liver disease or clotting disorders are suspected.

Endoscopy and Capsule Endoscopy

Endoscopy uses a thin, flexible tube with a camera to examine the GI tract for bleeding. For the upper GI tract, it is inserted through the mouth; for the lower GI tract, through the rectum. If bleeding is suspected in the small intestine, capsule endoscopy may be used, where the patient swallows a small, pill-sized camera that takes images as it moves through the digestive system.

Imaging Studies

If endoscopy does not reveal the bleeding source, imaging methods like CT angiography, radionuclide scanning, or barium studies may help. These scans detect active bleeding and areas missed by endoscopy. CT angiography is particularly useful for rapid or severe bleeding.

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Treatment Options for Gastrointestinal Bleeding

Non-Surgical Treatment
Endoscopic Procedures

Endoscopy is typically the first treatment approach for GI bleeding. Various techniques can be applied during the procedure to stop active bleeding, including banding (tying off bleeding veins), clipping (applying clips to close off bleeding vessels), or cauterisation (using heat to seal bleeding areas). Banding is often used for bleeding oesophageal varices, while cauterisation is effective for treating bleeding ulcers.

Medications

Treatment depends on the bleeding cause. Proton pump inhibitors (PPIs) reduce stomach acid to promote healing in peptic ulcers. Vasoconstrictors may help control bleeding from oesophagal varices. Antibiotics can be prescribed for infections such as H. pylori in peptic ulcer cases.

Blood Transfusions

In cases of significant blood loss, blood transfusions may be needed to replenish blood volume and treat anaemia. Transfusions help restore normal blood levels, especially if blood loss is severe enough to affect blood pressure or cause a substantial drop in haemoglobin.

Surgical Treatment
Resection Surgery

In severe cases or when other treatments fail, surgery may be required. Resection surgery involves removing the damaged part of the GI tract to stop further bleeding. This is often done for areas affected by conditions like cancer, diverticulitis, or severe ulcers. The surgeon then reconnects the healthy sections to restore normal function.

Managing Gastrointestinal Bleeding

Management focuses on treating the underlying condition, monitoring recovery, and reducing recurrence risk. Lifestyle changes, such as reducing alcohol, non-steroidal anti-inflammatory drugs, and smoking, can lower irritation risks. Regular follow-ups, dietary modifications, and routine check-ups help ensure successful management and reduce rebleeding chances.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Are there any warning signs before a severe GI bleed occurs?

    While sudden severe GI bleeding may not have clear warnings, chronic GI conditions can have early signs like mild abdominal discomfort, small amounts of blood in stool, frequent fatigue, and unexplained anaemia.

    Can gastrointestinal bleeding recur after treatment?

    Yes, GI bleeding can recur if the underlying condition is not fully managed. For instance, untreated H. pylori infection in peptic ulcers, continuing heavy alcohol use, or ongoing NSAID use can increase the risk of rebleeding.

    How long does it take to recover from a GI bleed?

    Recovery time varies depending on the severity of the bleed and the underlying cause. Minor bleeding may resolve with a few days of rest and treatment, while more severe cases might require hospital stays, follow-up tests, and a longer recovery period.

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