6/21/2018
`
`Bleeding in the Digestive Tract | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
`
`NIDDK > Health Information > Health Topics > Digestive Diseases > Bleeding in the Digestive Tract
`
`Bleeding in the Digestive Tract
`
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`
`On this page:
`
`What is bleeding in the digestive tract?
`What is the digestive tract?
`What causes bleeding in the digestive tract?
`What are the signs and symptoms of bleeding in the digestive tract?
`How is the cause of bleeding in the digestive tract diagnosed?
`How is bleeding in the digestive tract treated?
`How can bleeding in the digestive tract be prevented?
`Eating, Diet, and Nutrition
`Points to Remember
`Hope through Research
`For More Information
`Acknowledgments
`
`What is bleeding in the digestive tract?
`Bleeding in the digestive tract is any type of bleeding that starts in the digestive
`tract. Bleeding in the digestive tract is a symptom of a disease rather than a
`disease itself. Health care providers describe two types of bleeding:
`
`acute bleeding—sudden and sometimes severe bleeding
`chronic bleeding—slight bleeding that lasts for a long time or may come
`and go
`
`[Top]
`
`What is the digestive tract?
`The digestive tract, also called the gastrointestinal (GI) tract, is a series of hollow
`organs joined in a long, twisting tube from the mouth to the anus. Food enters the
`mouth and passes to the anus through the hollow organs of the GI tract. The
`upper GI tract includes the mouth, esophagus, stomach, and duodenum. The
`duodenum is the first part of the small intestine. The lower GI tract consists of the
`large intestine—which includes the colon and rectum—and anus.
`
`Alternate
`Versions
`
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`
`Additional
`Links
`
` Colonoscopy
`
`Colon Polyps
`
`Hemorrhoids
`
`Peptic Ulcer
`Disease
`
`Upper GI
`Endoscopy
`
`Contact Us
`
`Digestive Disease
`Information
`
`Phone: 1-800-891-
`5389
`TTY: 1-866-569-
`1162
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`nddic@info.niddk.ni
`h.gov
`Hours: 8:30 a.m. to
`5 p.m. eastern
`time, M-F
`
`Digestive
`Disease
`Organizations
`
`There are many
`organizations who
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`patients and medical
`professionals. View
`the full list of
`Digestive Disease
`Organizations (PDF,
`341 KB)
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`
`
`The digestive tract, also called the GI tract, is a series of hollow organs joined in a
`long, twisting tube from the mouth to the anus.
`
`[Top]
`
`What causes bleeding in the digestive tract?
`A variety of conditions can cause bleeding in the digestive tract. Locating the
`source of bleeding is an important step to help the health care provider find the
`cause of the bleeding. Different conditions can cause bleeding in the upper or
`lower GI tract.
`
`Causes of bleeding in the upper GI tract may include
`
`peptic ulcers—sores in the lining of the esophagus, stomach, or duodenum.
`The bacteria Helicobacter pylori (H. pylori) and use of nonsteroidal anti-
`inflammatory drugs (NSAIDs) can cause peptic ulcers. Peptic ulcers can
`wear away the mucosa, or the stomach or duodenal lining, and cause
`bleeding. Read more about Peptic Ulcer Disease, Peptic Ulcer Disease and
`H. pylori, and Peptic Ulcer Disease and NSAIDs.
`esophageal varices—enlarged blood vessels in the esophagus that can
`leak blood or even rupture, causing life-threatening bleeding. Esophageal
`varices are usually associated with a chronic liver condition called cirrhosis.
`Read more in Cirrhosis.
`a Mallory-Weiss tear—tears in the lower end of the esophagus. A person
`can have more than one Mallory-Weiss tear. Severe vomiting causes these
`tears.
`gastritis—a condition in which the stomach lining is inflamed. Some
`common causes of gastritis include the use of NSAIDs and other
`medications, infections, Crohn’s disease, critical illnesses, and severe
`injuries. If untreated, gastritis can lead to ulcers or erosions in the stomach
`lining that can bleed. Read more in Gastritis.
`esophagitis—an irritation of the esophagus. The most common cause of
`esophagitis is gastroesophageal reflux (GER), a condition that occurs when
`stomach acid flows back up into the esophagus. GER happens when the
`muscle between the esophagus and the stomach—the lower esophageal
`sphincter—is weak or relaxes when it should not. Stomach acid can
`damage the esophagus and cause sores and bleeding. Read more in
`Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease
`(GERD) in Adults.
`
`Causes of bleeding in the lower GI tract may include
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`hemorrhoids or fissures. Hemorrhoids are swollen and inflamed veins
`around the anus or in the lower rectum. Constipation and straining during
`bowel movements cause the veins to swell. Hemorrhoids cause itching,
`pain, and sometimes bleeding. Fissures are small tears in the anus that can
`cause bleeding. Read more in Hemorrhoids.
`diverticular disease—a condition that occurs when a person has problems
`from small pouches, or sacs, that have formed and pushed outward
`through weak spots in the colon wall. Each pouch is called a diverticulum.
`Multiple pouches are called diverticula. Sometimes a small blood vessel in
`a diverticulum bursts and causes bleeding in the lower GI tract. Read more
`in Diverticular Disease.
`colitis—inflammation of the colon. A complication of colitis is ulcers in the
`large intestine that can cause bleeding. Read more in Ulcerative Colitis.
`angiodysplasia—abnormal or enlarged blood vessels in the lower GI tract
`that can become fragile and bleed.
`colon polyps—abnormal growths of tissue in the lining of the colon. A
`person can have more than one colon polyp. Some colon polyps are
`benign, which means they are not cancerous. Some types of polyps may
`already be cancerous or can become cancerous. People who have colon
`polyps may be more likely to develop colorectal cancer. Colorectal cancer
`is the third most common cancer in the United States and often causes
`occult bleeding—blood in the stool that is not visible to the naked eye.1
`Sometimes polyps in the lower GI tract and rectum can cause bleeding.
`Read more in Colon Polyps.
`
`Causes of bleeding in both the lower and upper GI tract may include
`
`benign tumors and cancer. Benign tumors and cancer in the esophagus,
`stomach, colon, or rectum may cause bleeding when they weaken the
`lining of the GI tract. A benign tumor is an abnormal tissue growth that is
`not cancerous. Read more at www.cancer.gov.
`
`1Common cancer types. National Cancer Institute website.
`www.cancer.gov/cancertopics/commoncancers. Updated January 25, 2013.
`Accessed March 12, 2014.
`
`[Top]
`
`What are the signs and symptoms of bleeding in the digestive tract?
`The signs and symptoms of bleeding in the digestive tract depend on the location
`and severity of bleeding.
`
`Signs and symptoms of bleeding in the upper or lower GI tract may include
`
`acute bleeding, which may include abdominal cramps
`black or tarry stool
`bright red blood in vomit
`dark or bright red blood mixed with stool
`dizziness or faintness
`fatigue, or feeling tired
`paleness
`shortness of breath
`vomit that looks like coffee grounds
`weakness
`
`A person with acute bleeding may go into shock, which is an emergency condition.
`A person in shock may have additional signs and symptoms that may include
`
`a rapid pulse
`a drop in blood pressure
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`little or no urine output
`unconsciousness
`
`When a person has any signs or symptoms of shock, 911 should be called
`immediately.
`
`Chronic bleeding. A person with chronic bleeding may develop anemia, a
`condition in which red blood cells are fewer than normal, which prevents the
`body’s cells from getting enough oxygen. Symptoms of anemia may include
`fatigue and shortness of breath, which can develop over time.
`
`Some people may have occult bleeding. Occult bleeding may be a sign of
`inflammation or a disease such as colorectal cancer. A simple lab test can detect
`occult blood in the stool.
`
`[Top]
`
`How is the cause of bleeding in the digestive tract diagnosed?
`To diagnose bleeding in the digestive tract, the health care provider will first
`determine the site of the bleeding based upon the following:
`
`medical and family history
`physical exam
`lab tests
`nasogastric lavage
`upper GI endoscopy, enteroscopy, and capsule endoscopy
`colonoscopy and flexible sigmoidoscopy
`imaging tests
`other tests
`
`Medical and Family History
`Taking a medical and family history is one of the first things a health care provider
`may do to help determine the cause of digestive tract bleeding. Patients should
`report all medications they are taking to their health care provider.
`
`Physical Exam
`A physical exam may help diagnose the cause of bleeding in the digestive tract.
`During a physical exam, a health care provider usually
`
`examines a patient’s body
`uses a stethoscope to listen to sounds in the abdomen
`taps on specific areas of the patient’s body
`
`Lab Tests
`The health care provider may use the following lab tests to help determine the
`cause of digestive tract bleeding:
`
`Stool test. A stool test is the analysis of a sample of stool. The health care
`provider will give the patient a container for catching and storing the stool.
`The patient will return the sample to the health care provider or a
`commercial facility that will send the sample to a lab for analysis. Stool
`tests can show occult bleeding.
`Blood test. A blood test involves drawing blood at a health care provider’s
`office or a commercial facility and sending the sample to a lab for analysis.
`The blood test can help determine the extent of the bleeding and whether
`the patient has anemia.
`
`Nasogastric Lavage
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`During this procedure, a health care provider uses a nasogastric tube to remove
`the stomach contents. The health care provider will spray a numbing medication
`on the back of the patient’s throat before the procedure. The health care provider
`inserts a nasogastric tube through the nose or mouth, down the esophagus, and
`into the stomach. The procedure helps determine the cause of upper GI tract
`bleeding. A health care provider performs a nasogastric lavage in an outpatient
`center or a hospital.
`
`Upper Gastrointestinal Endoscopy, Enteroscopy, and Capsule
`Endoscopy
`
`Upper GI endoscopy. This procedure involves using an endoscope—a
`small, flexible tube with a light—to see the upper GI tract. A
`gastroenterologist—a doctor who specializes in digestive diseases—
`performs the test at a hospital or an outpatient center. The
`gastroenterologist carefully feeds the endoscope down the esophagus and
`into the stomach and duodenum. A small camera mounted on the
`endoscope transmits a video image to a monitor, allowing close
`examination of the intestinal lining. A health care provider may give a
`patient a liquid anesthetic to gargle or may spray anesthetic on the back of
`the patient’s throat. A health care provider will place an intravenous (IV)
`needle in a vein in the arm to administer a sedative or general anesthesia.
`
`During the procedure, a gastroenterologist may obtain a biopsy to help
`diagnose the bleeding. A biopsy is a procedure in which a tiny piece of the
`GI tract lining is removed for examination with a microscope. The
`endoscopy may show the source of bleeding, such as an ulcer or
`esophageal varices. When the health care provider cannot see the source
`of the bleeding during the endoscopy, the patient has obscure bleeding.
`The gastroenterologist may repeat the endoscopy or use other procedures
`to find the cause of obscure bleeding. Read more in Upper GI Endoscopy.
`Enteroscopy. This procedure examines the small intestine with a special,
`longer endoscope. A gastroenterologist usually performs the test at an
`outpatient center or a hospital. The gastroenterologist carefully feeds the
`endoscope down the esophagus, into the stomach and duodenum, and
`then into the small intestine. Types of enteroscopy procedures may include
`push enteroscopy, which uses a long endoscope to examine the
`upper portion of the small intestine
`single- or double-balloon enteroscopy, which use balloons to help
`move the endoscope through the entire small intestine
`spiral enteroscopy, which uses a tube attached to an enteroscope
`that is rotated and acts as a cork screw to move the instrument into
`the small intestine
`Capsule endoscopy. Although this procedure can examine the entire
`digestive tract, it is used mostly to examine the small intestine. The patient
`swallows a capsule containing a tiny camera. As the capsule passes
`through the GI tract, the camera will transmit and record images to a small
`receiver device worn by the patient. When the recording is done, the
`images stored in the receiver are downloaded to a video monitor and
`reviewed by a gastroenterologist.
`
`Colonoscopy and Flexible Sigmoidoscopy
`
`Colonoscopy. Colonoscopy is a procedure that uses a long, flexible,
`narrow tube with a light and tiny camera on one end, called a colonoscope,
`to look inside the rectum and entire colon. Colonoscopy can show irritated
`and swollen tissue, ulcers, and polyps. A gastroenterologist performs this
`procedure at a hospital or an outpatient center. In most cases, light
`anesthesia and pain medication help patients relax for the test. Health care
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`providers will monitor patients’ vital signs and try to make patients as
`comfortable as possible.
`
` A
`
` health care provider places an IV needle in a vein in the arm to give the
`patient a sedative or anesthesia. For the test, the patient will lie on a table
`while the gastroenterologist inserts a colonoscope into the anus and slowly
`guides it through the rectum and into the colon. The scope inflates the large
`intestine with air to give the gastroenterologist a better view. The camera
`sends a video image of the intestinal lining to a video monitor, allowing the
`gastroenterologist to carefully examine the intestinal tissues. The
`gastroenterologist may move the patient several times and adjust the scope
`for better viewing. Once the scope has reached the opening to the small
`intestine, the gastroenterologist slowly withdraws it and examines the lining
`of the large intestine again. The gastroenterologist can see and treat any
`bleeding in the lower GI tract during a colonoscopy. Read more in
`Colonoscopy.
`Flexible sigmoidoscopy. Flexible sigmoidoscopy is a test that uses a
`flexible, narrow tube with a light and tiny camera on one end, called a
`sigmoidoscope, to look inside the rectum and the lower, or sigmoid, colon.
`A gastroenterologist performs a flexible sigmoidoscopy at a health care
`provider’s office, a hospital, or an outpatient center. The patient usually
`does not need anesthesia. For the test, the patient will lie on a table while
`the gastroenterologist inserts a sigmoidoscope into the anus and slowly
`guides it through the rectum and into the sigmoid colon. The scope inflates
`the large intestine with air to give the gastroenterologist a better view. The
`camera sends video images of the intestinal lining to a video monitor,
`allowing the gastroenterologist to carefully examine the tissues lining the
`sigmoid colon and rectum. The gastroenterologist can see and treat any
`bleeding in the sigmoid colon and rectum during a flexible sigmoidoscopy.
`Read more in Flexible Sigmoidoscopy.
`
`Imaging Tests
`To help find the cause of digestive tract bleeding, a health care provider may order
`one or more of the following imaging tests. An x-ray technician performs these
`tests in an outpatient center or a hospital, and a radiologist—a doctor who
`specializes in medical imaging—interprets the images. Patients do not need
`anesthesia.
`
`Abdominal computerized tomography (CT) scan. An abdominal CT
`scan uses a combination of x rays and computer technology to create
`images. For a CT scan, a health care provider may give the patient a
`solution to drink and an injection of a special dye, called contrast medium.
`CT scans require the patient to lie on a table that slides into a tunnel-
`shaped device where the technician takes x rays. Abdominal CT scans can
`help find the cause of digestive tract bleeding.
`Lower GI series. A lower GI series is an x-ray exam that a health care
`provider uses to look at the large intestine. The health care provider may
`provide written bowel prep instructions to follow at home before the test.
`The health care provider may ask the patient to follow a clear liquid diet for
`1 to 3 days before the procedure. A patient may need to use a laxative or
`an enema before the test. A laxative is medication that loosens stool and
`increases bowel movements. An enema involves flushing water or laxative
`into the rectum using a special squirt bottle.
`
`For the test, the patient will lie on a table while the radiologist inserts a
`flexible tube into the patient’s anus. The x-ray technician will fill the large
`intestine with barium, a chalky liquid, making the signs of underlying
`problems show up more clearly on x rays. The test can show problems with
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`the large intestine that are causing the bleeding.
`
`Barium liquid in the GI tract causes white or light-colored stools for several
`days or longer. Enemas and repeated bowel movements may cause anal
`soreness. A health care provider will provide specific instructions about
`eating and drinking after the test. Read more in Lower GI Series.
`Upper GI series. This test is an x-ray exam that provides a look at the
`shape of the upper GI tract to help determine the cause of digestive tract
`bleeding. A patient should not eat or drink before the procedure, as
`directed by the health care provider. Patients should ask their health care
`provider about how to prepare for an upper GI series.
`
`During the procedure, the patient will stand or sit in front of an x-ray
`machine and drink barium. Barium coats the esophagus, stomach, and
`small intestine so the radiologist and a gastroenterologist can see the
`organs’ shapes more clearly on x rays. A patient may experience bloating
`and nausea for a short time after the test. For several days afterward,
`barium liquid in the GI tract causes white or light-colored stools. A health
`care provider will give the patient specific instructions about eating and
`drinking after the test. Read more in Upper GI Series.
`
`Other Tests
`A health care provider also may order one or more of the following tests to
`determine the cause of digestive tract bleeding:
`
`Angiogram. An angiogram is a special kind of x ray in which an
`interventional radiologist—a specially trained radiologist—threads a thin,
`flexible tube called a catheter through the large arteries, often from the
`groin, to the artery of interest. The radiologist injects contrast medium
`through the catheter so the artery and site of bleeding show up more clearly
`on the x ray. During the procedure, the interventional radiologist can inject
`medications or other materials to stop some types of bleeding. The
`interventional radiologist performs the procedure and interprets the images
`in a hospital or an outpatient center. A patient does not need anesthesia,
`though a light sedative may help reduce a patient’s anxiety during the
`procedure. This test can help diagnose the cause of digestive tract
`bleeding.
`Exploratory procedures. When a patient has acute bleeding that cannot
`be controlled and none of the other tests helps the health care provider
`diagnose the source of the bleeding, a surgeon may perform one of two
`operations called an exploratory laparotomy or laparoscopy.
`During a laparotomy, a surgeon will make a cut, or incision, in the
`abdomen and explore the abdomen to find the cause of the
`bleeding. During the operation, the surgeon can treat the problems
`that cause the bleeding. The patient receives general anesthesia.
`During a laparoscopy, a surgeon makes several small incisions in
`the abdomen and inserts special tools and a camera to try to locate
`and treat the source of the bleeding. The patient will receive general
`anesthesia.
`Radionuclides scan. A radionuclides scan can help find the cause of
`digestive tract bleeding. A specially trained technician performs this scan in
`an outpatient center or a hospital. The technician takes a sample of the
`patient’s blood, mixes it with radioactive material and injects it back into the
`patient’s body to highlight the area in the body that is bleeding. The dose of
`radioactive chemicals is small, so the chance of causing damage to cells is
`low. A special camera takes pictures that highlight the radioactive material.
`The patient does not need anesthesia.
`
`[Top]
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`How is bleeding in the digestive tract treated?
`Treatment depends on the cause or location of the bleeding. During a laparotomy,
`a colonoscopy, or an endoscopy, a gastroenterologist can stop the bleeding by
`inserting tools through the endoscope or colonoscope to
`
`inject medications into the bleeding site
`treat the bleeding site and surrounding tissue with a heat probe, an electric
`current, or a laser
`close affected blood vessels with a band or clip
`
`An interventional radiologist can use an angiogram to inject medications or other
`materials into blood vessels to stop some types of bleeding. When infections or
`ulcers cause the bleeding, health care providers prescribe medications to treat the
`problem. When a person has severe acute bleeding or bleeding that does not
`stop, a surgeon may need to perform a laparoscopy or laparotomy to stop the
`bleeding.
`
`[Top]
`
`How can bleeding in the digestive tract be prevented?
`Health care providers can prevent bleeding in the digestive tract by treating the
`conditions that cause the bleeding. People can prevent some of the causes of
`digestive tract bleeding by
`
`limiting the amount of NSAIDs they take or by talking with a health care
`provider about other medication options
`following a health care provider’s recommendations for treatment of GER
`
`[Top]
`
`Eating, Diet, and Nutrition
`People can prevent digestive tract bleeding by avoiding foods and triggers, such
`as alcoholic drinks and smoking, that can increase stomach acids and lead to
`ulcers. People who have a history of diverticular disease, anal fissures, and
`hemorrhoids should follow the diet their health care provider recommends to help
`prevent repeat bleeding. Read more in Hemorrhoids and Diverticular Disease.
`
`[Top]
`
`Points to Remember
`
`Bleeding in the digestive tract is any type of bleeding that starts in the
`digestive tract.
`Bleeding in the digestive tract is a symptom of a disease rather than a
`disease itself.
`A variety of conditions can cause bleeding in the digestive tract.
`Locating the source of bleeding is an important step to help the health care
`provider find the cause of the bleeding.
`Treatment depends on the cause or location of the bleeding.
`
`[Top]
`
`Hope through Research
`The National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK’s)
`Division of Digestive Diseases and Nutrition conducts and supports basic and
`clinical research into many digestive disorders.
`
`Clinical trials are research studies involving people. Clinical trials look at safe and
`effective new ways to prevent, detect, or treat disease. Researchers also use
`clinical trials to look at other aspects of care, such as improving the quality of life
`
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`for people with chronic illnesses. To learn more about clinical trials, why they
`matter, and how to participate, visit the NIH Clinical Research Trials and You
`website at www.nih.gov/health/clinicaltrials. For information about current studies,
`visit www.ClinicalTrials.gov.
`
`[Top]
`
`For More Information
`American College of Gastroenterology
`6400 Goldsboro Road, Suite 200
`Bethesda, MD 20817
`Phone: 301–263–9000
`Fax: 301–263–9025
`Email: info@acg.gi.org
`Internet: www.gi.org
`
`American Gastroenterological Association
`4930 Del Ray Avenue
`Bethesda, MD 20814
`Phone: 301–654–2055
`Fax: 301–654–5920
`Email: member@gastro.org
`Internet: www.gastro.org
`
`[Top]
`
`Acknowledgments
`Publications produced by the Clearinghouse are carefully reviewed by both NIDDK
`scientists and outside experts. This publication was reviewed by David A. Peura,
`M.D., University of Virginia Health System.
`
`You may also find additional information about this topic by visiting
`MedlinePlus at www.medlineplus.gov.
`
`This publication may contain information about medications and, when taken
`as prescribed, the conditions they treat. When prepared, this publication
`included the most current information available. For updates or for questions
`about any medications, contact the U.S. Food and Drug Administration toll-
`free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult
`your health care provider for more information.
`
`[Top]
`
`National Digestive Diseases Information Clearinghouse
`2 Information Way
`Bethesda, MD 20892–3570
`Phone: 1–800–891–5389
`TTY: 1–866–569–1162
`Fax: 703–738–4929
`Email: nddic@info.niddk.nih.gov
`Internet: www.digestive.niddk.nih.gov
`
`The National Digestive Diseases Information Clearinghouse (NDDIC) is a service
`of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
`The NIDDK is part of the National Institutes of Health of the U.S. Department of
`Health and Human Services. Established in 1980, the Clearinghouse provides
`information about digestive diseases to people with digestive disorders and to their
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`Patent Owner Ex. 2070
`Mylan v. Pozen
`IPR2017-01995
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`6/21/2018
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`Bleeding in the Digestive Tract | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
`families, health care professionals, and the public. The NDDIC answers inquiries,
`develops and distributes publications, and works closely with professional and
`patient organizations and Government agencies to coordinate resources about
`digestive diseases.
`
`This publication is not copyrighted. The Clearinghouse encourages users of this
`publication to duplicate and distribute as many copies as desired.
`
`NIH Publication No. 14–1133
`July 2014
`
`[Top]
`
`Page last updated September 17, 2014
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`Page 10 of 10
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`Patent Owner Ex. 2070
`Mylan v. Pozen
`IPR2017-01995
`
`