Symptoms & Causes of GI Bleeding

What are the symptoms of GI bleeding?

Gastrointestinal (GI) bleeding symptoms depend on the type of GI bleeding you have. If you have symptoms of acute or severe GI bleeding, seek medical help right away.

Acute GI bleeding

Acute bleeding begins suddenly and can sometimes be severe. You may notice symptoms, such as

• black or tarry stool
• dark or bright red blood mixed with stool
• bright red blood in vomit
• vomit that looks like coffee grounds

Acute GI bleeding may have other symptoms, such as

• having cramps or pain in your abdomen
• fainting or feeling lightheaded or dizzy
• feeling tired
• having shortness of breath

If acute GI bleeding is severe, you could go into shock. Symptoms of shock include

• confusion or unconsciousness
• fast heart rate
• pale skin
• cold hands and feet
• sweating

Shock is life-threatening. If you have symptoms of shock, seek emergency medical help right away.

Chronic GI bleeding

Chronic GI bleeding may cause you to have a small amount of blood in your stool. If the amount of blood is too small for you or your doctor to see, it is called occult bleeding. Doctors can order stool and blood tests to check for occult bleeding.

In some cases, chronic GI bleeding causes mild symptoms that come and go over time. In addition, you may have variable symptoms and notice that your stool is sometimes black and tarry or sometimes mixed with bright red blood.

Over time, chronic bleeding can cause anemia. Symptoms of anemia may include

• feeling tired
• pale skin
• shortness of breath

If the amount of bleeding suddenly increases, you may have symptoms of acute GI bleeding. If you have symptoms of acute GI bleeding, seek medical help right away.

What causes GI bleeding?

A variety of diseases and conditions can cause GI bleeding, and these vary by where in the GI tract the bleeding takes place.

Upper GI bleeding

Causes of upper GI bleeding include6

• peptic ulcers, sores on the lining of the stomach or duodenum that may bleed. The most common causes of peptic ulcers are Helicobacter pylori (H. pylori) infection and taking nonsteroidal anti-inflammatory drugs (NSAIDs)—such as aspirin, ibuprofen, and naproxen—and blood thinners.
• gastritis, which occurs when the stomach lining is inflamed or damaged. This condition may lead to shallow breaks or ulcers in the stomach lining that bleed. Causes of gastritis include H. pylori infection, taking NSAIDs and blood thinners, and drinking alcohol.
• esophagitis, inflammation in the esophagus that may lead to ulcers and bleeding. Esophagitis is often caused by gastroesophageal reflux disease.
• varices—enlarged veins—in the esophagus or stomach that can cause bleeding if the veins burst. Varices are most often related to cirrhosis.
• Mallory-Weiss tears, tears in the lower esophagus that can bleed. These tears are often caused by severe vomiting.
• benign tumors or cancer, which may occur in the esophagus or stomach. These abnormal growths can weaken the lining of the GI tract, exposing blood vessels and causing bleeding.

Small bowel bleeding

Causes of small bowel bleeding include7,8

• angiodysplasia, a condition in which blood vessels in the GI tract are abnormal or enlarged. These abnormal or enlarged blood vessels can become weak and bleed.
• inflammation in the small bowel, which may lead to erosions and ulcers and cause bleeding. Causes of small bowel inflammation include Crohn’s disease, NSAIDs, and infections.
• polyps, benign tumors, or cancer, which may occur in the small bowel. These abnormal growths can weaken the lining of the GI tract and cause bleeding.

Lower GI bleeding

Causes of lower GI bleeding include9

• diverticular disease, in which small pouches, or sacs, form and push outward through weak spots in the wall of your colon. Diverticular bleeding occurs when a small blood vessel within the wall of a pouch bursts.
• hemorrhoids, swollen and inflamed veins around your anus or in your lower rectum that may bleed, or anal fissures, small tears that also can cause itching, tearing, or bleeding in your anus.
• polyps, benign tumors, or cancer, which may occur in the colon or rectum. These abnormal growths can weaken the lining of the GI tract and cause bleeding.
• colitis, inflammation in the colon that may lead to ulcers and bleeding. Causes of colitis include lack of blood flow to the colon, inflammatory bowel disease (IBD)—such as ulcerative colitis or Crohn’s disease—and infections.

References

[6] Rockey DC. Causes of upper gastrointestinal bleeding in adults. UpToDate. Updated July 13, 2022. Accessed March 12, 2024. www.uptodate.com/contents/causes-of-upper-gastrointestinal-bleeding-in-adults

[7] Brar HS, Shah NJ. Small bowel bleeding. StatPearls [Internet]. StatPearls Publishing; March 6, 2023. Accessed July 17, 2024. www.ncbi.nlm.nih.gov/books/NBK568709

[8] Murphy B, Winter DC, Kavanagh DO. Small bowel gastrointestinal bleeding diagnosis and management—a narrative review. Frontiers in Surgery. 2019;6:25. Published May 16, 2024. Accessed April 10, 2024. www.ncbi.nlm.nih.gov/pmc/articles/PMC6532547

[9] Strate L. Etiology of lower gastrointestinal bleeding in adults. UpToDate. Updated January 30, 2023. Accessed March 12, 2024. www.uptodate.com/contents/etiology-of-lower-gastrointestinal-bleeding-in-adults