Upper gastrointestinal bleeding (patient information)

Upper gastrointestinal bleeding
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Upper gastrointestinal bleeding?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:; Assistant Editor(s)-In-Chief:

Overview

Upper gastrointestinal bleeding defined as abnormal blood loss from the esophagus (the tube that connects the mouth and stomach), the stomach, or the duodenum (the first foot of the small intestine that follows the stomach).

What are the symptoms of Upper gastrointestinal bleeding?

Upper gastrointestinal bleeding is usually seen as

• Bloody vomit
• Vomit that looks like coffee grounds
• Bowel movements that are black and sticky

What causes Upper gastrointestinal bleeding?

• The most common cause of upper GI bleeding is an ulcer in the stomach or small intestine.
• Irritation of the stomach or esophagus can also cause an upper GI bleed.
• A group of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, are common causes of stomach and esophagus irritation. *Another common cause of bleeding is liver disease from chronic alcohol use. Sometimes the esophagus bleeds because it is torn after forceful coughing or vomiting.

Who is at highest risk?

Common risk factors in the development of upper gastrointestinal bleeding include:

• Advancing age
• Previous history of gastrointestinal bleed
• Chronic kidney disease
• Underlying cardiovascular disease
• Cirrhosis and portal hypertension
• Presence of H.pylori infection
• NSAID's or aspirin use in patients with a history of ulcer disease
• Patients taking glucocorticoids

Diagnosis

If your doctor or nurse suspects you have a GI bleed, he or she will order 1 or more of the following tests:

• Blood tests:
  
  • To check if you have enough red blood cells (the cells that carry oxygen).
  • To check if your blood is clotting normally.
  • To check if your liver is working normally.
• An upper endoscopy
  • For this test, a doctor gives you medicine to make you sleepy and relaxed.
  • Then he or she puts a thin tube called an endoscope in your mouth and down your throat.
  • The tube has a light on the end and a camera that sends images of your GI tract to a TV screen.
  • If the doctor sees any spots that are bleeding, he or she can use tools that go through the endoscope to help stop the bleeding.
• A colonoscopy
  • This test is similar to an endoscopy, but it involves going in through the rectum.
  • Imaging tests that involve putting a dye or weakly radioactive chemical into the blood so that doctors can trace where the blood goes.
• A capsule endoscopy
  • This test uses a small camera about the size of a vitamin pill.
  • You swallow the camera, and it sends pictures to a recording device that you wear on a belt for 8 hours.
  • A doctor then looks at the pictures.
  • This test lets doctors look at the small intestine, which is hard to see with endoscopy or colonoscopy because it is very long.
  • After the test, the camera will pass with a bowel movement. Most people never see it come out.

When to seek urgent medical care?

See your doctor right away if you:

• Vomit blood or something that looks like coffee grounds
• Have a bowel movement that looks like tar or has blood in it
• Feel weak, light-headed, or woozy
• Have a racing heartbeat
• Have severe belly pain
• Turn much paler than normal

Treatment options

Depending on how much blood you have lost and what seems to be causing your bleeding, you might get 1 or more of these treatments:

• Oxygen through a mask or a tube that sits under your nose
• Blood or fluids into 1 of your veins (to replace blood you lost)
• Medicines to reduce stomach acid
• Medicines help clean out and empty your gut (so that doctors can see clearly what is happening inside)
• Antibiotics
• A small tube that goes up your nose and down your throat so doctors can rinse out your stomach.
• Depending on where the bleed seems to be, you might also have an endoscopy. This can help the doctors find the spot or spots that are bleeding. Plus, doctors can sometimes use the endoscope to seal off blood vessels and stop them from bleeding.
• After the bleeding has stopped, your doctor or nurse will probably want to follow up with you to learn why you started bleeding in the first place.
• If you have ulcers or another condition that could lead to bleeding, the doctor or nurse will want to make sure those problems are treated.

Where to find medical care for Upper gastrointestinal bleeding?

Directions to Hospitals Treating Condition

Prevention

You can lower your chances of getting a GI bleed by:

• Not taking medicines called NSAIDs too often, unless your doctor tells you it is OK.
  • Examples of these medicines include aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand names: Aleve, Naprosyn).
• If you have to take these medicines on a regular basis, your doctor might give you another medicine to decrease your risk of bleeding.
• Being treated for stomach ulcers if you have them
• Taking medicines called beta blockers if you have cirrhosis and your doctor prescribes them.