Gastrointestinal Bleeding – Diagnosis and Treatment
Diagnosis
When checking for causes of gastrointestinal (GI) bleeding, health professionals use a mix of patient history, physical exams, lab work, and special tests.
The first step is asking questions about previous episodes, symptoms such as melena or bright red blood, any known conditions like peptic ulcer disease, and a review of current medications.
Physical exams can reveal signs like anemia, abdominal pain, or rectal masses. A digital rectal examination may identify hemorrhoids, fissures, or masses causing rectal bleeding.
Common Tests Used
| Test Name | What It Checks | Area Observed |
|---|---|---|
| Complete Blood Count | Anemia, infection, and bleeding severity | Blood |
| Coagulation Profile | Blood clotting problems | Blood |
| Liver Function Tests | Liver disease, portal hypertension | Blood |
| Fecal Occult Blood Test | Hidden blood in stool | Stool |
| Upper Endoscopy | Peptic ulcers, varices, Mallory-Weiss tears | Esophagus, stomach, duodenum |
| Colonoscopy | Polyps, colon cancer, diverticulosis | Large intestine, rectum |
| Capsule Endoscopy | Small bowel bleeding, angiodysplasia | Small intestine |
| Flexible Sigmoidoscopy | Inflammatory bowel disease, ischemic colitis | Sigmoid colon, rectum |
| Angiography | Bleeding vessel, vascular lesions | Blood vessels |
| CT Scan | Tumors, obscure bleeding | Abdomen and pelvis |
| Nasogastric Lavage | Blood in stomach, rapid assessment | Stomach |
If a patient shows symptoms like hematemesis (vomiting blood), hematochezia (passing bright red blood), or black, tarlike stool (melena), clinicians can sometimes narrow down the location of the bleed.
Sometimes, advanced methods are necessary. Balloon-assisted enteroscopy allows doctors to view sections of the small intestine that standard scopes cannot reach. Capsule endoscopy helps identify causes of obscure bleeding in the small bowel.
For patients who have recurrent bleeding or suspected lesions that endoscopy and colonoscopy cannot find, angiography or CT scans can reveal vascular lesions, active bleeding, or tumors.
If noninvasive methods do not pinpoint a cause and the bleeding is severe, surgeons may need to directly inspect the small intestine and other hard-to-reach areas.
Doctors use endoscopy and colonoscopy to identify bleeding sources like peptic ulcers, diverticulosis, polyps, and colorectal cancer, and they can sometimes treat these during the same procedure.
In certain cases, especially with lower GI bleeding, clinicians may perform anoscopy to check for internal hemorrhoids or anal fissures. They select tests based on the patient’s reported symptoms, severity, and suspected causes.
Treatment
Treatment for GI bleeding depends on the cause and severity. Many cases resolve on their own, but active or heavy bleeding often needs medical intervention.
First, doctors check a patient’s hemodynamic status and may provide normal saline through an IV to help with low blood pressure or shock. Blood transfusions might be given if there is major blood loss.
Medicines and Interventions commonly used:
- Proton pump inhibitors to decrease stomach acid.
- Epinephrine injection or vasopressin to slow or stop bleeding.
- Endoscopic intervention, such as band ligation or direct treatment during endoscopy.
- Removal of blood using a nasogastric tube (NGT) with a suction device.
- Risk stratification to decide how urgent the treatment should be.
If medicine or endoscopy cannot control bleeding, angiography can help find and treat the source, or surgeons may perform surgery (like exploratory laparotomy). The treatment goal is to achieve hemostasis, stabilize the patient, and reduce hospital stay.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Patients should prepare for their appointment by gathering important information and staying organized. Make a list of all current symptoms, even if some do not seem related to gastrointestinal bleeding. Note the start date and any changes in symptoms.
It is helpful to write down the names and dosages of all medications, including over-the-counter drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), blood thinners, and any vitamins or supplements.
This is especially important for people with conditions like cardiovascular disease, ischemic heart disease, or liver disease, as certain drugs can increase the risk of bleeding.
People should also bring a list of past digestive problems, such as GERD, ulcers, or inflammatory bowel disease, along with dates of diagnosis and treatments received.
Preparing questions in advance can help make sure nothing is forgotten—some good topics include the possible causes of symptoms, needed tests, alternatives to recommended treatments, and how other illnesses may affect or be affected by treatment.
If possible, bringing a friend or family member to the appointment may help with remembering details and instructions. Below is a table to help gather what to bring:
| Item | Example(s) |
|---|---|
| List of current symptoms | Blood in stool, abdominal pain, fatigue |
| Medication list | NSAIDs, dabigatran, vitamins |
| Medical history | Ulcers, GERD, liver disease |
| Family health history | Digestive disorders, bleeding issues |
| Prepared questions | Causes, tests, treatment options |
What the Doctor Might Ask or Do
During the visit, the healthcare provider will likely review the patient’s medical history and ask about the pattern, frequency, and severity of symptoms.
The doctor may ask specific questions about the use of aspirin, NSAIDs, and alcohol, as these can contribute to gastrointestinal bleeding.
Expect questions about how long symptoms have been happening, what makes them better or worse, and if similar problems have happened before. The physician might review all medications, looking for any blood thinners or anticoagulants in use.
The healthcare provider may also discuss any related conditions, such as heart or liver diseases, to understand the bigger health picture.
Sometimes, based on symptoms and history, the doctor may recommend further diagnostic tests right away, such as blood work or imaging.
