Some Causes and Features of Gastrointestinal Bleeding
Cause* | Common Features† | Tests |
|---|---|---|
Upper digestive tract (indicated by vomiting blood or dark brown, coffee-ground material) | ||
Ulcers or erosions of the esophagus, stomach, or first part of the small intestine (duodenum) | Pain that
Painless ulcers can also cause bleeding | Upper GI endoscopy (examination of esophagus, stomach, and duodenum using a flexible viewing tube called an endoscope) |
Esophageal varices (enlarged veins in the esophagus) | Usually very heavy bleeding Often in people known to have chronic liver disease such as cirrhosis Sometimes signs of chronic liver disease such as a swollen abdomen and yellowish discoloration of the skin and whites of the eyes (jaundice) | Upper GI endoscopy |
Mallory-Weiss tear (a tear in the esophagus caused by vomiting) | In people who vomited one or more times before they started vomiting blood Sometimes pain in the lower chest during vomiting | Upper GI endoscopy |
Abnormal connections between the arteries and veins (arteriovenous malformations) in the intestine | Usually no other symptoms | Upper GI endoscopy |
Lower digestive tract (indicated by passing blood in the stool) | ||
Bright red blood only on toilet paper, dripping in the bowl, or on the surface of formed stools | Anoscopy (examination of the anus and rectum with a short, rigid tube) or sigmoidoscopy | |
Pain during bowel movements Bright red blood only on toilet paper or on the surface of formed stools Fissure seen during the doctor's examination | A doctor’s examination alone | |
Abnormal blood vessels (angiodysplasia) in the intestine | Painless Bright red blood from the rectum (hematochezia) Usually in people over age 60 (most common cause of large intestine bleeding in this age group) | Colonoscopy (examination of the entire large intestine, rectum, and anus using an endoscope) |
Inflammation of the large intestine due to radiation therapy, infection, or disruption of the blood supply (as occurs in ischemic colitis) | Bloody diarrhea, fever, and abdominal pain | Colonoscopy Stool tests to look for infectious organisms Sometimes CT scan |
Sometimes fatigue, weakness, and/or a bloating sensation Usually in middle-aged or older people | Colonoscopy and biopsy (examination of tissue samples taken from the lining of the intestine) | |
Often no other symptoms | Colonoscopy | |
Diverticular disease (such as diverticulosis) | Painless hematochezia Sometimes in people already known to have diverticular disease | Colonoscopy Sometimes CT scan or CT angiography Rarely angiography (x-rays taken after injecting a dye into an artery using a catheter) |
Inflammatory bowel disease (such as ulcerative proctitis, ulcerative colitis, or Crohn disease) | Bloody diarrhea, fever, and abdominal pain and cramps Sometimes in people who have had several episodes of bleeding from the rectum | Colonoscopy and biopsy |
* Causes are listed in order from the most common to the least in each section. | ||
† Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
CT = computed tomography; GI = gastrointestinal. | ||