Gastrointestinal (GI) Tract Bleeding

What is gastrointestinal tract bleeding?

Gastrointestinal (GI) bleeding, also known as gastrointestinal haemorrhage, indicates a problem within your digestive system. This issue presents itself as blood in your vomit or stool, which may not always be immediately evident. When visible, your stool may appear dark or have a black, tarry consistency. The severity of GI bleeding can vary, extending from minor to severe conditions that could be life-threatening.

What causes gastrointestinal tract bleeding?

Bleeding within the gastrointestinal (GI) tract is typically affected by specific conditions. Based on the affected region, it is categorised as upper or lower GI bleeding.

Upper GI bleeding may be caused by:

• Peptic ulcers
• Oesophageal varices
• Oesophageal (Mallory Weis)
• Severe haemorrhagic gastritis or duodenitis
• Trauma from ingestion of foreign body/caustic substance ingestion
• Bleeding upper GI tumours
• Angiodysplasia

Lower GI bleeding may be caused by:

• Haemorrhoids
• Anal fissures
• Diverticular bleed
• Colon cancer
• Angiodysplasia
• Large colorectal polyps
• Colitis

What are the symptoms of gastrointestinal tract bleeding?

The symptoms of gastrointestinal bleeding will vary based on severity. However, typical symptoms of gastrointestinal bleeding include:

• Black or tarry stool consistency
• Vomiting bright red blood
• Abdominal cramps
• Dark or bright red blood in stool
• Experiencing dizziness or fainting sensation
• Fatigue
• Skin paleness
• Difficulty breathing or shortness of breath
• General weakness or lack of strength
• Vomit that looks like coffee grounds

Is gastrointestinal tract bleeding painful?

Gastrointestinal (GI) tract bleeding can cause discomfort or cramps, but the pain intensity is usually mild unless there is severe inflammation. 

Who is at risk of gastrointestinal tract bleeding in Singapore?

Individuals at risk of gastrointestinal (GI) tract bleeding include:

• History of GI bleeding: individuals with a history of GI bleeding are at a higher risk of future bleeding, requiring continuous surveillance and management of the condition. 
• Smoking: tobacco use or smoking has been linked to an increased risk of gastrointestinal bleeding.
• Alcohol consumption: excessive alcohol consumption is known to worsen the risk of gastrointestinal bleeding due to its damaging effects on the digestive tract.
• Age and medical conditions: older individuals are more prone to this condition due to frequent use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelets and anticoagulants (warfarin). Chronic conditions such as chronic renal disease and cirrhosis lead to increased risks of bleeding. 
• Gender: men might have a slightly higher risk of certain types of GI bleeding. Additionally, consuming spicy foods, experiencing stress, and struggling with constipation can lead to less severe but common causes of GI bleeding, such as haemorrhoids (piles) and anal fissures.

Individuals with these risk factors must be aware of the potential for GI bleeding and manage underlying conditions appropriately. Regular check-ups and discussions with your specialist about the risks of medications and lifestyle choices can help reduce your risk of GI bleeding.

How is gastrointestinal tract bleeding diagnosed in Singapore?

When you notice symptoms such as blood in your stool or vomit, it is essential to seek medical attention in Singapore as it may indicate signs of gastrointestinal (GI) bleeding or various digestive system disorders. Gastrointestinal tract bleeding is diagnosed in the following ways:

• Medical history and physical examination: your specialist will start by reviewing your medical history and performing a physical exam to understand the cause of the bleeding. This initial evaluation is crucial for a diagnostic plan tailored to your symptoms and health status.
• Blood test: to further investigate the cause of GI bleeding, blood tests will be ordered to detect signs of anaemia or other indicators of blood loss. 
• Faecal occult blood test: a faecal occult blood test (FOBT) may also be conducted to check for hidden blood in your stool, which can determine bleeding within your digestive tract.
• Gastroscopy: for a more detailed view of your digestive tract, you will have to undergo a gastroscopy. A gastroscopy allows for the examination of your oesophagus, stomach, and the beginning of the small intestine, which can help identify sources of upper GI bleeding. 
• Colonoscopy: alternatively, a colonoscopy may be used to view your lower GI tract, including the colon and rectum, especially if the bleeding is suspected to originate from these areas.
• Imaging tests: in cases where these initial methods do not provide a clear diagnosis, imaging tests such as CT angiography or nuclear scintigraphy might be utilised. These will indicate active bleeding sites, especially in acute situations. 

Depending on the severity of your condition, your specialist may use a combination of these diagnostic approaches to effectively identify the cause of your GI bleeding and work towards resolving the underlying condition.

What are the treatment options for gastrointestinal tract bleeding in Singapore?

If you are experiencing gastrointestinal (GI) tract bleeding in Singapore, the treatment method will depend on factors such as the cause, location, and severity.

Common treatment methods for gastrointestinal bleeding include:

• Medication adjustments: if you are on blood thinners such as aspirin or NSAIDs, your doctor may need to make adjustments to reduce the risk of further bleeding.
• Endoscopic procedures:
  • Endoscopic haemostasis: endoscopic haemostasis may involve an injection of adrenaline or application of clips to stop bleeding.
  • Polypectomy: if polyps are the cause, removing them via a polypectomy with a hot snare and applying clips can stop the bleeding.
• Thermal coagulation: thermal coagulation uses heat to cauterise bleeding vessels and stop the bleeding.
• Surgery: in cases where endoscopic treatment is insufficient, surgical intervention may be necessary. Procedures such as laparoscopy or laparotomy are options to control your bleeding.
• Medications:
  • Proton pump inhibitors (PPIs): proton pump inhibitors can reduce stomach acid and help prevent further bleeding, and they are especially useful for people with peptic ulcers.
• Supportive care: this includes fluid resuscitation and possibly blood transfusions to stabilise your condition before further treatment.
• Management of underlying conditions: addressing any conditions that may have contributed to your bleeding, such as liver disease or a bleeding disorder, is also an important part of your treatment plan.
• Dietary management: while not a direct treatment for GI bleeding, you may be advised to adjust your diet and avoid irritants such as alcohol and spicy foods during your recovery.

Frequently asked questions

Can GI tract bleeding stop on its own?

Some minor GI tract bleeds, especially from small ulcers or haemorrhoids, may stop without intervention. However, it is important to seek medical evaluation because bleeding can recur or indicate a more serious underlying condition.

When should I see a doctor for GI tract bleeding?

You should seek immediate medical attention if you experience significant or persistent bleeding, signs of substantial blood loss (such as fainting, rapid heartbeat, or low blood pressure), or if the bleeding is accompanied by severe abdominal pain, fever, and/or vomiting.

Are there ways to prevent GI tract bleeding?

Preventive measures may include managing risk factors for the conditions that lead to GI bleeding. This can involve avoiding excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs), limiting alcohol consumption, treating and monitoring for H. pylori infection, maintaining a healthy lifestyle to prevent conditions such as diverticulosis and haemorrhoids, and undergoing regular screenings for colorectal cancer.

Can stress cause GI tract bleeding?

While stress alone is not typically a direct cause of GI tract bleeding, it can worsen underlying conditions such as peptic ulcers or inflammatory bowel disease, which can lead to bleeding. Managing stress through lifestyle changes or therapy may help reduce the risk of GI tract bleeding.

Is GI tract bleeding serious?

The seriousness of GI tract bleeding varies. It can range from minor, with minimal treatment, to life-threatening, requiring immediate medical intervention. The severity often depends on the source of the bleeding, the amount of blood lost and your overall health.