Gastrointestinal (GI) bleeding refers to blood loss occurring within the digestive tract, which spans from the mouth to the anus. This can manifest as passing fresh or altered blood from the anal canal or vomiting fresh or altered blood. Sometimes the blood passed in stools can appear black and foul smelling and is called malena. GI bleeding is a symptom of digestive tract disorder(s), including reflux, ulcers and cancers. In severe cases, the bleeding can be life-threatening and thus requires immediate medical attention.
This bleeding can be broadly classified into two main categories: upper and lower bleeding, which are determined by the location of the bleeding source. Furthermore, GI bleeds encompass various types, including:
Acute: marked by sudden onset of bleeding
Chronic: bleeding that occurs intermittently over time
Occult: bleed symptoms are not visible
Overt: bleeding symptoms are visibly apparent
What Causes Gastrointestinal Bleeding?
One of the causes of gastrointestinal bleeding is peptic ulcers that penetrate a blood vessel in the stomach or duodenum, causing significant bleeding.
The causes of GI bleeding vary depending on the location of the bleeding within the GI tract.
For cases of upper GI bleeding, the condition could be due to:
Depending on its location and associated symptoms, GI bleeding may or may not be painful. Regardless of the level of pain, it is inadvisable to ignore symptoms of major GI bleeding because it may lead to serious complications.
What Are the Symptoms of Major Gastrointestinal Bleeding?
When GI bleeding occurs, it can lead to inflammation and pressure within the abdomen, causing pain.
In overt cases, obvious symptoms include:
Vomiting of fresh blood or vomit with a dark, granular appearance like coffee grounds
Black, tarry stool or faeces covered in blood
Rectal bleeding
In more obscure cases, patients may experience:
Abdominal cramps
Difficulty breathing
Chest pains
Weakness and fatigue
How Is Major Gastrointestinal Bleeding Diagnosed?
One of the possible diagnostic procedures you may go through is gastroscopy which visualises the upper GI tract.
At ACE Specialist Surgery and Endoscopy, our general surgeon will inquire about patients' symptoms and may conduct some lab tests. Depending on the type of GI bleed, a different set of diagnostic tests may be conducted.
For Upper GI Bleeding:
Gastroscopy: Gastroscopy involves the insertion of an endoscope (thin, flexible tube, which has a light and camera at its tip), down the patient's throat, to access the upper GI tract (throat, oesophagus, stomach and duodenum) and diagnose upper GI bleeding.
Enteroscopy: Enteroscopy refers to the insertion of an endoscope through the mouth or rectum to visualise the small intestine.
For Lower GI Bleeding:
Colonoscopy: Colonoscopy isperformed by inserting an endoscope through the rectum to examine the large intestine.
Capsule Endoscopy: Patients will swallow a pill containing a small camera, which will capture images of their gastrointestinal tract as it passes through to detect the source of bleeding.
Imaging Tests: These tests, like X-ray and CT angiography, use a special dye to identify bleeding in patients.
Red Blood Cell Nuclear Scan: A harmless radioactive tracer is injected to monitor the movement of a patient’s red blood cells, which will be used to track the source of bleeding.
How Serious is Major Gastrointestinal Bleeding?
While mild bleeding may not pose an immediate risk, severe internal bleeding in the GI tract can be dangerous. Patients experiencing major GI bleeding may be at risk of life-threatening complications, including shock, anaemia, or even death.
What Are the Treatment Options for Major Gastrointestinal Bleeding in Singapore?
Non-surgical treatments:
Medication: Used to treat underlying causes such as haemorrhoids or infections. Proton pump inhibitors can reduce stomach acid and manage bleeding from ulcers.
Endoscopic treatments: Techniques such as endoscopic clipping, banding, or injecting medications directly at the bleeding site to control and stop the bleeding.
Blood transfusions: To replace lost blood and stabilise the patient, especially in cases of significant blood loss.
Surgical treatments:
In severe cases where other conservative treatments fail, surgery may be necessary to remove or repair the bleeding source
Suture ligation: This involves tying off the bleeding vessels directly to stop the bleeding.
Lesion or organ excision: Removing the bleeding lesion or affected part of the organ to control the bleeding.
Vagotomy: Cutting the vagus nerve to reduce acid secretion, often used in cases of recurrent ulcer bleeding.
Laparoscopy: Involving small incisions to locate and treat the source of bleeding using a camera and specialised instruments.
Laparotomy: Creating a big incision in the abdomen to access the GI tract and control severe bleeding directly.
When Should You Visit the A&E for Major Gastrointestinal Bleeding?
It is critical to seek urgent medical care from a general surgery clinic or call 995 to contact a nearby hospital’s Accident and Emergency (A&E) Department if you experience any of the following symptoms, as they indicate a potentially life-threatening condition that requires immediate medical attention:
Severe and rapid blood loss: This can manifest as vomiting large amounts of blood (hematemesis) or passing a significant amount of blood in the stool (hematochezia or melena).
Signs of shock: Symptoms such as rapid heartbeat, low blood pressure, cold and clammy skin, confusion, or loss of consciousness should prompt an immediate visit to A&E.
Severe abdominal pain: Accompanied by GI bleeding, severe pain could indicate a serious underlying condition requiring urgent evaluation.
Dizziness or fainting: Feeling light-headed or fainting can be signs of significant blood loss and should not be ignored.
Persistent or worsening symptoms: If GI bleeding continues or worsens despite initial treatment, it is crucial to seek emergency care.
Timely treatment is necessary to prevent serious complications and aid recovery. ACE Specialist Surgery and Endoscopy Clinic offers round-the-clock emergency services for major gastrointestinal bleeding cases. Patients experiencing GI bleeding can seek medical attention at any time for diagnosis and treatment. You can call us any time of the day (24/7), and we will strive to arrange an appointment or urgent operation with our general surgeon as soon as possible.
Summary
In conclusion, major gastrointestinal bleeding, which refers to significant blood loss occurring within the digestive tract, is typically a medical emergency that needs immediate surgery. People with major gastrointestinal bleeding are advised to seek urgent medical attention as soon as possible to prevent complications.
Visit ACE Specialist Surgery & Endoscopy
Major gastrointestinal bleeding can become life-threatening without immediate intervention. If you experience any of its symptoms, immediately, call us anytime, day or night, and we will schedule an appointment or urgent surgery with our Senior Consultant Endocrine and General Surgeon, Dr Reyaz Singaporewalla, as soon as possible.
Frequently Asked Questions
Can Major Gastrointestinal Bleeding stop on its own?
Although GI bleeding often stops spontaneously in mild cases, it is crucial to note that major GI bleeding cases will require medical diagnosis and treatment. This is to ensure that the source of bleeding is accurately determined and handled to avoid any life-threatening complications.
Who is at risk of Major Gastrointestinal Bleeding in Singapore?
It is important to note that certain individuals in the following categories may be more prone to experiencing GI bleeding:
Those aged 65 and above
Patients with a history of peptic ulcer disease, H. pylori infection, dyspepsia or GERD symptoms, etc.
Those taking medications like aspirin, blood thinners, ibuprofen, or steroids.
Can Major Gastrointestinal Bleeding be prevented?
To prevent a GI bleed:
Limit nonsteroidal anti-inflammatory drug usage.
Restrict alcohol consumption.
Quit smoking.
Follow your healthcare team's instructions for treating GERD.
Can Major Gastrointestinal Bleeding recur after treatment?
Yes, while GI bleeding may recur post-treatment, proper treatment and preventive measures contribute to a relatively low recurrence rate.
Kim, B. S., Li, B. T., Engel, A., Samra, J. S., Clarke, S., Norton, I. D., & Li, A. E. (2014). Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World journal of gastrointestinal pathophysiology, 5(4), 467:478. https://doi.org/10.4291/wjgp.v5.i4.467
