Gastrointestinal bleeding

What is Gastrointestinal Bleeding?

The gastrointestinal tract, also known as the digestive tract, consists of the mouth, oesophagus, stomach, small intestine, large intestine, rectum, and the anus. Gastrointestinal bleeding is blood loss from any one of the organs in your gastrointestinal tract.

Upper gastrointestinal bleeding occurs in your oesophagus, stomach, or the first part of the small intestine (duodenum). Lower gastrointestinal bleeding occurs in the large intestine (colon), rectum, or anus.

What causes Gastrointestinal Bleeding?

Upper Gastrointestinal Bleeding:

Peptic ulcers: Peptic ulcers are the most common cause of upper gastrointestinal bleeding. These are sores that develop on the lining of the duodenum and stomach. They can be caused by non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, blood thinners, and an infection by the helicobacter pylori (H. Pylori) bacteria.
Cancer: Pancreatic cancer, liver cancer, stomach cancer, and oesphageal cancer can cause gastrointestinal bleeding.
Tears in the lining of your oesophagus: Also known as Mallory-Weiss syndrome, oesophagus lining tears are common in alcoholics and can also be caused by excessive vomiting.
Tears in the veins of your oesophagus: Also known as oesophageal varices and characterised by enlarged veins which can tear and bleed. This is common in individuals with cirrhosis or severe liver scarring2.
Gastritis and duodenitis: Inflammation of the stomach and duodenum respectively. Both can be caused by the H. Pylori bacteria or by excessive consumption of NSAIDs and alcohol.
Oesophagitis: Inflammation of the oesophagus which is commonly caused by gastroesophageal disease (GERD).
Foreign objects: Sometimes ingesting foreign objects can cause gastrointestinal bleeding if it scrapes along the walls of the gastrointestinal tract.

Lower Gastrointestinal Bleeding:

Colitis: Colitis is one of the most common causes of lower gastrointestinal bleeding. It is an inflammation of the colon.
Piles (haemorrhoids): Enlarged vein in the rectum or anus which may rupture and cause bleeding.
Diverticular disease: Inflammation of the small pouches that develop along the walls of the gastrointestinal tract.
Tumours: Tumours (cancerous and non-cancerous) that grow in the colon, rectum, or anus can cause bleeding.
Anal fissure: A tear in the anal sphincter can cause gastrointestinal bleeding.
Proctitus: Inflammation of the rectum lining.
Irritable bowel disease (IBD): Namely Crohn’s disease and ulcerative colitis, the chronic inflammation of the gastrointestinal tract.

What are the symptoms of Gastrointestinal Bleeding?

Symptoms of gastrointestinal bleeding manifest differently as there are 2 main types of gastrointestinal bleeding. These are overt (obvious bleeding) and occult (not obvious or hidden bleeding).

Occult bleeding:

Abdominal cramps
Paleness
Tiredness
Shortness of breath
Chest pains
Fatigue and lethargy
Fainting

Overt bleeding:

Black, sticky stools
Rectal bleeding either with or in stools
Vomiting red or dark brown blood with the consistency of grounded coffee

Gastrointestinal bleeding may also be acute (comes on suddenly) or chronic (comes and goes over a period of time). Either way, it is a serious issue and should be dealt with as soon as possible. If left untreated, excessive gastrointestinal bleeding can cause iron-deficiency anaemia or you could go into shock.

The symptoms of shock are:

Losing consciousness
Fast pulse
Drop in blood pressure
Weakness

Who is at risk of Gastrointestinal Bleeding in Singapore?

Risk factors associated with gastrointestinal bleeding include:

Overuse of NSAIDs (e.g., aspirin, ibuprofen)
Alcoholism
Blood thinners or anticoagulants
H. Pylori infection
Over the age of 64
Chronic renal failure
GERD
Diabetes mellitus

How is Gastrointestinal Bleeding diagnosed in Singapore?

If you notice any signs of gastrointestinal bleeding, it is imperative that you seek professional help and describe your symptoms clearly. You may be asked if there is a family history of gastrointestinal bleeding, what your medical history is, and if you are allergic to anything.

The diagnostic tools for lower and upper gastrointestinal bleeding are different.

Diagnosing upper gastrointestinal bleed:

Gastroscopy

Most used when diagnosing an upper gastrointestinal bleed. A thin and flexible wire with a light and camera attached to one end, also known as a gastroscope, is inserted into your mouth and gently led through through your oesophagus and then into your stomach and duodenum.

Deep Enteroscopy

Only used if an endoscopy was unable to find the source of the bleeding. It involves and endoscope coupled with a balloon that helps to open your duodenum and check for bleeding.

Diagnosing lower gastrointestinal bleed:

Colonoscopy

A thin, flexible tube with a light and camera attached at one end is inserted into your rectum to find the cause of the gastrointestinal bleeding. A biopsy may be required if samples were taken from your gastrointestinal tract.

X-ray

A tracer will be given to you intravenously; it will light up during the x-ray and help to pinpoint the source of your bleeding.

Capsule endoscopy

You will have to swallow a pill that contains a small camera which will then take pictures of your gastrointestinal tract as it moves through it.

Computed tomography (CT) angiography

A CT-scan is similar to an x-ray but with clearer and more accurate details.

Red blood cell nuclear scan

A tracer is given to you intravenously which can show the performance of red blood cells in your body.

What are the treatment options for gastrointestinal bleeding in Singapore?

Most of the time, gastrointestinal bleeding is not permanent and can stop on its own. However, if it is a chronic condition, then treatment will depend on the site and cause of bleeding.

Some treatment options include:

Medication to treat haemorrhoids or infections
Proton inhibitor pump can be used for the treatment of bleeding induced by GERD, this helps to reduce stomach acid
Colonoscopy or gastroscopy can help to remove polyps or lesions causing the bleed

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal