Bleeding in the digestive tract is always a serious matter and can be the result of various conditions. Some causes can be life-threatening, but most conditions can be cured or controlled, such as hemorrhoids and ulcers. If bleeding occurs in the digestive tract, it is critical to find the source of the bleeding. Bleeding can occur anywhere in one or more areas of the gastrointestinal system, consisting of the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus. The bleeding can be hidden (occult or not visible to the human eye), but stool tests can identify it. Depending on whether the location of the bleeding is higher or lower in the tract, the blood can vary from black or tarry to bright red.

The longer the blood takes to exit, the darker it will be.

What causes bleeding in the digestive tract?

In the esophagus, bleeding can result from several conditions:

Esophagitis can occur in the lower end of the esophagus. The esophagus can become inflamed by the acidic contents of the stomach which enter the esophagus when the lower esophageal sphincter muscle malfunctions. This condition is often associated with heartburn and GERD (gastroesophageal reflux disease).

In the stomach, infections, ulcers, and inflammations (gastritis) can lead to bleeding: 
• Infections can be caused by Helicobacter pylori bacteria and medicines, such as aspirin and NSAIDS (medications used for muscular and joint pain). High levels of H. pylori bacteria can be identified in blood tests.
• Ulcers or gastritis can develop from the irritated lining of the stomach. Acute or chronic ulcers can erode through blood vessels to cause massive bleeding. Stress ulcers can be caused by burns, head injuries, shock, extensive surgery, or cancer.
• Benign tumors or cancer of the stomach may bleed.

In the small intestine, bleeding is often caused by duodenal ulcers and inflammations:

• Ulcers can be found in the upper part of the small intestine called the duodenum. They can result from H. pylori bacteria or medications such as aspirin, aspirin-containing medicines, and NSAIDS.
• Crohn’s disease can cause inflammation in the small intestine as well as in other parts of the gastrointestinal tract. It often affects the lower end of the small intestine called the ileum where it can lead to bleeding.
• Cancer of the small intestine is a possibility

• In the large intestine (colon), benign growths may develop or inflammations can produce bloody diarrhea:

  • Benign growths or polyps can cause bleeding, which may be occult (hidden) and identifiable in stool tests, or visible bleeding. During endoscopic exams, these growths can be removed since they are believed to lead to cancer of the colon.
  • Inflammations can be another cause of extensive bleeding in the colon. Intestinal infections, ulcerative colitis, Crohn’s disease, and diverticular disease can all inflame the walls of the colon.
  • Cancer of the colon is the third most common form of cancer in the United States. It usually develops from polyps which can be removed in a sigmoidoscopy or colonoscopy exam. People over the age of 50 are recommended to have colorectal endoscopic exams to identify colon cancer in its early stages when it is most curable.
  • Abnormalities in blood vessels may develop as people age, which can bleed.

Written by Joy Seeman

© 2009 Hemorrhoid Information Center

Sources:

Bleeding in the Digestive Tract. (2004, November). Retrieved September 25, 2009, from National Digestive Disease Clearinghouse: http://digestive.niddk.nih.gov

Digestive Basics–Bleeding in the Digestive Tract. (2004, February 6). Retrieved September 25, 2009, from About.com: http://ibdcrohns.about.com

Mohan, M. D. , Venkat. (2008, September 13). Bleeding in the Digestive Tract. Retrieved September 24, 2009, from WebMD: http://www.webmd.com

If you are experiencing colorectal problems or are over the age of 50, your doctor will probably want to do some diagnostic testing of the colon, often called the large intestine. Many problems, such as hemorrhoids, anal fissures, diverticulosis, colitis or rectal bleeding, can lead you to your doctor’s waiting room. Because a routine examination is usually inconclusive, your healthcare provider will probably order some diagnostic testing to find the cause of your symptoms.

There are several diagnostic procedures for colorectal problems:

• Barium enema tests are usually done in the radiology department of a hospital. You will receive instructions on how to clean out your colon before the procedure. After lying down on an X-ray table, barium will be inserted into your colon through a lubricated tube which is monitored by a healthcare provider. Often air is introduced into the large intestine as well to enhance the image on the X-ray fluoroscope screen which is similar to a TV monitor. As you lie on the table, it will be slightly tipped at times, and you will be asked to take different positions to accommodate the x-ray pictures. After the exam, the tube will be removed, and you will be helped to the toilet, so the barium can drain out.
• Sigmoidoscopy is an examination of the last third of the large intestine, called the sigmoid or descending colon. It is less preferable to the colonoscopy which can examine the whole colon. However, a sigmoidoscopy can be done quickly in your doctor’s office (in about twenty minutes) and without as much preparation as a colonoscopy. An enema is given an hour or two before the procedure to remove all solids from the descending colon. You will lie on your side while the doctor inserts a long, flexible, lighted tube into the anus and the sigmoid colon. A camera on the scope will transmit an image of the colon to a computer screen which the doctor views for any abnormalities. Since you are awake during the exam, there can be mild discomfort from the endoscope and the air which is added to inflate the walls of the colon. If any growths, called polyps, are found, they can be removed during the procedure and biopsied.
• Virtual colonoscopy or computed tomographic colonography (CTC) is a newer procedure to find abnormalities in the colon and has been much debated to its effectiveness. It is noninvasive, and uses x-rays and computers to produce 3-D images of the large intestine, after you have completed the same extensive prep as for a standard colonoscopy. Most studies show that CTC is as efficient as the other exam at finding polyps, but the drawback is that the growths cannot be removed during the procedure. Also, Medicare has announced it will no longer cover the expense, even though the exam is much less expensive than a regular colonoscopy. Only patients who would be considered at a low risk for polyps and other abnormalities are advised to have a virtual colonoscopy.
• Colonoscopy is an examination of the whole length of the colon for irregularities with a lighted, flexible tube called an endoscope. Your doctor will thread this scope up through your colon and watch the findings from the scope’s camera on a computer screen. If lesions or polyps are found, they can be removed immediately with instruments inserted through the scope. According to most patients, the worst part of the procedure is the day-long prep before the exam to clean out the colon. As patients lie on their side in a hospital setting, anesthesia is used to make them comfortable and unaware. Better techniques and the improved skill of physicians have contributed to the ease and reliability of this exam in recent years. The colonoscopy is considered the gold standard of colorectal procedures.

Your healthcare providers will be the best advisors of which test to undergo for your particular situation, and you need to rely on their expertise. However, it is helpful to know what is involved in each procedure, so you are aware of the medical care that you are receiving.

Written By Joy Seeman

(c) 2009 Hemorrhoid Information Center

Sources:

Barium enema. (2008, March 8). Retrieved August 13, 2008, from Medline Plus: http://hlm.nih.gov/medlineplus

Colonoscopy. (2008, November). Retrieved August 14, 2009, from Medline Plus: http://nlm.nih.gov/medlineplus

Flexible Sigmoidoscopy. (2008, November). Retrieved August 13, 2009, from National Digestive Diseases Information Clearinghouse: http://digestive.niddk.nih.gov

Laino, C. (2008, January 28). Virtual or Real, Colonoscopy is Best. Retrieved August 13, 2009, from WebMD: http://www.webmd.com

Sigmoidoscopy. (2008, March 8). Retrieved August 13, 2009, from Medline Plus: http://hlm.nih.gov

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