Approach to Upper Gastrointestinal Bleeding – Causes, Symptoms and Treatment

Any bleeding in the Oesophagus, stomach, or upper small intestine is called Upper Gastrointestinal Bleeding. It’s a warning sign of something more serious going on with your body.

About 100k people a year seek medical attention for an upper gastrointestinal bleed. Extreme bleeding is potentially fatal and needs immediate attention.

This article examines upper GI bleeds, discussing their causes and available treatments.

What is Upper GI Bleeding?

When the upper digestive tract sustains an injury or develops inflammation, upper GI bleeding can result. A gastrointestinal bleed is not a disease but a symptom of another condition. According to where the blood comes from, doctors classify gastrointestinal (GI) bleeds as upper or lower.

Bleeding in the upper GI tract can occur in the following ways:

• esophagus
• stomach
• The first section of the small intestine is the duodenum.

GI bleeds can be either sudden or ongoing. While chronic bleeding occurs over a longer period and is typically less noticeable, acute bleeding occurs suddenly and severely. Without treatment, both can lead to potentially fatal complications for the patient.

Upper Gastrointestinal Bleeding Symptoms

Symptoms of Upper Gastrointestinal Bleeding vary depending on the location of the bleeding and the rate of bleeding. Some of the signs of a gastrointestinal bleed are:

• A Black, tarry stool
• Coloured or coffee-ground-looking vomit
• Pain in the Stomach
• unusually pale skin
• fainting, dizziness, or fatigue
• weakness

Blood in the faeces that is not readily apparent indicates occult bleeding. A doctor can see blood in the stool by looking for it.

When to ask for aid

Upper Gastrointestinal Bleeding can have dire consequences. People should not delay getting medical attention if they suddenly experience gastrointestinal (GI) bleeding symptoms. Shock is a medical emergency that can result from acute gastrointestinal bleeding.

Here are some of the signs:

• Rapid heartbeat
• Blood pressure going down
• Hardly any need to urinate
• Unconsciousness

The digestive tract may bleed more slowly and for a longer duration in cases of chronic GI bleeding. However, it can still cause serious health problems like anaemia. During physical activity, anaemic people often experience dizziness, fatigue, and shortness of breath. Additionally, they could be paler than usual.

Anyone worried they may be suffering from anaemia or a chronic gastrointestinal bleed should immediately schedule an appointment with their doctor.

Causes of Upper Gastrointestinal Bleeding

The origin of Upper Gastrointestinal Bleeding can vary widely. For example:

1. Stomach sores

Peptic ulcers, or stomach and duodenal ulcers, are open sores in the gastrointestinal tract. Infection with Helicobacter pylori or sensitivity to NSAIDs like aspirin or ibuprofen are the most common causes.

Unfortunately, many people with ulcers have no idea they have it. Possible signs of illness include:

• Distress, most frequently in the upper tummy
• Sickness and throwing up
• Being overly full or bloated

2. Esophagitis

Inflammation of the oesophagus is known as esophagitis. Gastroesophageal reflux disease (GERD) is the most common cause, but medications, infections, and allergies also play a role.

Esophagitis symptoms include:

• Difficulty swallowing because of chest pain
• Challenges with swallowing
• Sickness and throwing up
• Absence of hunger
• Persistent hacking cough

Heartburn and acid reflux can be chronic problems for those with gastroesophageal reflux disease.

3. Enteritis

Inflammation of the small intestine (enteritis) typically results from a bacterial or viral infection. Radiation therapy, certain medications, alcohol, and inflammatory bowel disease (IBD) are potential causes of enteritis.

Symptoms of infectious enteritis include stomach pain, vomiting, diarrhoea, cramping, and even rectal bleeding.

4. Tears of Mallory-Weiss

Common causes of esophageal perforations include persistent vomiting and coughing. There may be a lot of bleeding from Mallory-Weiss tears. It’s not always the case, but sometimes they’ll heal independently. Treatment may be necessary to staunch the bleeding and prevent severe blood loss in some cases.

5. Varices of the Oesophagus

The lower end of the Oesophagus is prone to developing varices, which are enlarged veins. Cirrhosis and other forms of liver disease significantly increase their prevalence.

A person with esophageal varices might only notice anything if the veins start bleeding. In the event of a rupture, these vessels can bleed heavily. Here are some of the signs:

• Hurting tummy
• Bloody vomit
• Bloody faeces

6. Gastritis

Inflammation of the stomach, also known as gastritis. Most people with gastritis don’t even know they have it because there are no symptoms.

• Discomfort in the upper tummy
• satiated on a small amount of food
• lack of hunger
• loss of weight without trying

Gastritis is an inflammation of the stomach lining that, if left untreated, can eventually result in ulcers and bleeding. Causes include NSAID use, injury, inflammatory bowel disease, and infection.

7. Cancer

In rare cases, cancer can cause bleeding in the upper gastrointestinal tract. Esophageal cancer symptoms often include:

• Challenges with swallowing
• An ongoing cough
• Bloody vomit
• Heartburn
• Abnormally low body weight

The upper gastrointestinal tract is not the only body part where cancer can manifest and cause bleeding.

Upper Gastrointestinal Bleeding Diagnosis

A doctor will take a patient’s medical history and conduct a physical exam to determine if bleeding is the cause of their symptoms. The next step could involve questions about the patient’s symptoms, bowel habits, and stool colour.

Sometimes, the doctor may refer the patient to a gastroenterologist or order diagnostic tests. They may use a battery of tests, including:

• Stool analysis: These are useful for detecting infections like H. pylori, inflammation, and occult bleeding.
• Analysing the blood: This evaluation can detect anaemia.
• Enteroscopy or Upper Endoscopy: A doctor will insert an endoscope down the patient’s oesophagus to examine the stomach or small intestine.
• Intestinal washings: To identify the cause of internal bleeding, it is necessary to empty the patient’s stomach.
• One that involves a biopsy: A doctor will take a tissue sample from the area of concern and have it analysed in a lab.
• Diagnostic imaging: CT scans and barium X-rays are two such examples.

Treatment of Upper GI Bleeding

An upper gastrointestinal bleed’s treatment options depend on the location, severity, and aetiology of the bleeding.

• When someone goes to the ER because of severe bleeding, the first order of business is to staunch the bleeding. A physician might do this by
• directly injecting medication into the wound to stop bleeding
• probe or laser thermal therapy for treating the bleeding site
• Clipping the blood vessel shut to prevent bleeding

If doctors can pinpoint the source of the bleeding, they can use one of these techniques in conjunction with diagnostic procedures like an endoscopy.

To stop the bleeding, it is necessary to treat the underlying cause of it. This therapy may consist of:

• Prescription drug therapy, such as antibiotics for H. pylori infection treatment or proton pump inhibitors (PPIs) for ulcer healing by reducing stomach acid production.
• Stopping drugs or behaviours (like NSAIDs) contributes to ulceration and bleeding.
• If the doctor has tried everything else and the bleeding still won’t stop, they may suggest surgery.
• A blood transfusion or intravenous fluids may be necessary for those who have lost significant blood.

Conclusion

Internal bleeding, sudden and severe or more gradual and chronic, is always a medical emergency. Anyone experiencing symptoms consistent with a GI bleed should seek medical attention immediately.

Medication, heat, and surgery are all options for treating Upper Gastrointestinal Bleeding. Stopping the bleeding requires treating the underlying cause.