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What Are the Common Causes of Bleeding in the Digestive Tract?

Esophagus

• Inflammation (esophagitis)

• Enlarged veins (varices)

• Mallory-Weiss syndrome

Stomach

• Ulcers

• Inflammation (gastritis)

Small Intestine

• Duodenal ulcer

Large Intestine and Rectum

• Hemorrhoids

• Inflammation (ulcerative colitis)

• Colorectal polyps

• Colorectal cancer

• Diverticular disease

Bleeding in the Digestive tract

Bleeding in the digestive tract is a symptom of digestive problems rather than a disease itself.  Bleeding can occur as the result of a number of different conditions, many of which are not life threating.  Most causes of bleeding are related to conditions that can be cured or controlled, such as hemorrhoids.  The cause of bleeding may not be serious, but locating the source of bleeding is important.

The digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum and anus.  Bleeding can come from one or more of these areas, that is, from a small area such as an ulcer on the lining of the stomach or from a large surface such as an inflammation of the colon.  Bleeding can sometimes occur without the person noticing it.  This type of bleeding is called occult or hidden.  Fortunately, simple tests can detect occult blood in the stool.

What Causes Bleeding in the Digestive Tract?

Stomach acid can cause inflammation that may lead to bleeding at the lower end of the esophagus.  This condition is called esophagitis or inflammation of the esophagus.  Sometimes a muscle between the esophagus and stomach fails to close properly and allows the return of food and stomach juices into the esophagus, which can lead to esaphagitis.  In addition, enlarged veins (varices) at the lower end the esophagus may rupture and bleed massively.  Cirrhosis of the liver is the most common cause of esophageal varices.  Esophageal bleeding can be caused by Mallory-Weiss syndrome, a tear in the lining of the esophagus.  Mallory-Weiss syndrome usually results from prolonged vomiting but may also be caused by increased pressure in the abdomen from coughing, hiatal hernia, or childbirth.

The stomach is a frequent site of bleeding.  Alcohol, aspirin, aspirin-containing medicines, and various other medicines (particularly those used for arthritis) can cause stomach ulcers or inflammation (gastritis).  The stomach is often the site of ulcer disease.  Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding.  Also, patients suffering from burns, shock, head injuries, or cancer, or those who have undergone extensive surgery may develop stress ulcers.  Bleeding can occur from benign tumors or cancer of the stomach, although these disorders usually do not cause massive bleeding. 

The most common source of bleeding from the upper digestive tract is ulcers in the duodenum (the upper small intestine).  Researchers now believe that these are caused by excess stomach acid and infection with Helicobacter pylori bacteria. 

In the lower digestive tract, the large intestine and rectum are frequent sites of bleeding.  Hemorrhoids are probably the most common cause of visible blood in the digestive tract, especially blood that appears bright red.  Hemorrhoids are enlarged veins in the anal area that can rupture and produce bright red blood, which can show up in the toilet or on toilet paper.  If red blood is seen, however, it is essential to exclude other causes of bleeding since the anal area may also be the site of cuts (fissures), inflammation, or tumors.

Benign growths or polyps of the colon are very common and are thought to be forerunners of cancer.  These growths can cause either bright red blood or occult bleeding.  Colorectal cancer is the second most frequent of all cancers in the United States and usually causes bleeding at some time.

Inflammation from various causes can produce extensive bleeding from the colon.  Different intestinal can cause inflammation and bloody diarrhea.  Ulcerative colitis can produce inflammation and extensive surface bleeding from tiny ulcerations.  Crohn’s disease of the large intestine can also produce spotty bleeding.

Diverticular disease caused by diverticular—outpouchings of the colon wall—can result in massive bleeding.  Finally, as one gets older, abnormalities may develop in the blood vessels of the large intestine, which may result in recurrent bleeding.

How Is Bleeding in the Digestive Tract Recognized?

The signs of bleeding in the digestive tract depend upon the site and severity of bleeding.  If blood is common from the rectum or the lower colon, bright red blood will coat or mix with the stool.  The stool may be mixed with darker blood if the bleeding is higher up in the colon or at the far end of the small intestine.  When there is bleeding in the esophagus, stomach, or duodenum, the stool is usually black or tarry.  Vomited material may be bright red or have a coffee—grounds appearance when one is bleeding from those sites.  If bleeding is occult, the patient might not notice any changes in stool color.