Gastrointestinal bleeding (GI bleed) or gastrointestinal hemorrhage, is a term collectively given to bleeding from the mouth to the rectum of the gastrointestinal tract. When the bleeding persists, various other symptoms may occur such as melena (black, tarry stools), coffee ground vomitus, hematemesis (vomiting bright red blood), chest pain, abdominal pain etc.
GI bleeding can be upper gastrointestinal bleeding (upper esophagus, stomach, and duodenum) or lower gastrointestinal bleeding (colon and rectum). Peptic or stomach ulcers are among the causes of gastrointenstinal bleeding most commonly found in the patients with upper GI bleeding.
Outlining pathophysiology of bleeding due to peptic ulcer
GI bleeding is a signal of having a digestive disorder and peptic ulcers have various etiologies leading to the development of sores in the mucosal lining of the stomach. The common symptoms of a stomach ulcer include upper abdominal pain, vomiting, poor appetite etc. In almost 15% of the patients with gastric ulcer, GI bleed is found to occur. When the pH of the stomach becomes too acidic by the oversecretion of gastric acids such as HCl and pepsin, the mucosal lining forming protective barrier is degraded which increases causing erosion and subsequently ulcers.
The main causes of peptic ulcer are:
- Helicobacter pylori (H. Pylori) infection: pH-sensitive bacteria that penetrate the mucosal layer and colonize, causing stomach infection and inflammation.
- Use of non-steroidal anti-inflammatory drugs (NSAIDs) aspirin, ibuprofen, etc causes topical irritation of epithelial cells of the lining initially and inhibits COX-2 (Cyclooxygenase) enzyme-induced production of protective prostaglandins.
- Smoking and alcohol
- Radiation therapy
- Stomach cancer
Diagnosis starts with taking a medical history, validating symptoms, examination and blood tests like a fecal occult blood test to confirm the bleeding. An immediate upper endoscopy helps in locating the area of bleeding and further treatment of the ulcers. Hospitalization and blood transfusion may be needed in very severe cases when antibiotics, acid blockers, etc do not work effectively.