Bleeding in the

Digestive Tract

National Digestive Diseases Information Clearinghouse

Bleeding in the digestive tract is a symptom

of a disease rather than a disease itself. A
number of different conditions can cause
bleeding. Most causes of bleeding are Esophagus
U.S. Department related to conditions that can be cured
of Health and
Human Services
or controlled, such as ulcers or hemor­
rhoids. Some causes of bleeding may be
NATIONAL life threatening. Stomach
INSTITUTES Duodenum
OF HEALTH Locating the source of bleeding is important.
Different conditions cause bleeding in the Colon
upper digestive tract and the lower digestive (shaded)
tract. The upper digestive tract includes the
esophagus, stomach, and upper portion of
the small intestine, also called the duode­ Small
intestine
num. The lower digestive tract includes the
lower portion of the small intestine; large Rectum Anus
intestine, which includes the colon and
rectum; and anus. The digestive tract

What are the signs of

bleeding in the digestive • dark blood mixed with stool
tract? • stool mixed or coated with bright red
The signs of bleeding in the digestive tract blood
depend on the site and severity of bleeding. Signs of bleeding in the lower digestive tract
Signs of bleeding in the upper digestive tract include
include • black or tarry stool
• bright red blood in vomit • dark blood mixed with stool
• vomit that looks like coffee grounds • stool mixed or coated with bright red
• black or tarry stool blood
Sudden, severe bleeding is called acute What causes bleeding in the
bleeding. If acute bleeding occurs, symptoms
may include
digestive tract?
A variety of conditions can cause bleeding in
• weakness the digestive tract. Causes of bleeding in the
• dizziness or faintness upper digestive tract include the following:
• shortness of breath • Peptic ulcers. Helicobacter pylori
(H. pylori) infections and long-term use
• crampy abdominal pain
of nonsteroidal anti-inflammatory drugs
• diarrhea (NSAIDs), such as aspirin and ibupro­
• paleness fen, are common causes of peptic ulcers.

A person with acute bleeding may go into • Esophageal varices. Varices, or

shock, experiencing a rapid pulse, a drop enlarged veins, located at the lower end
in blood pressure, and difficulty producing of the esophagus may rupture and bleed
urine. massively. Cirrhosis is the most com­
mon cause of esophageal varices.
Light bleeding that continues for a long time
• Mallory-Weiss tears. These tears in the
or starts and stops is called chronic bleeding.
lining of the esophagus usually result
If bleeding is chronic, a person may notice
from vomiting. Increased pressure in
that fatigue, lethargy, and shortness of breath
the abdomen from coughing, hiatal her­
develop over time. Chronic blood loss can
nia, or childbirth can also cause tears.
also lead to anemia, a condition in which the
blood’s iron-rich substance, hemoglobin, is • Gastritis. NSAIDs and other
diminished. drugs, infections, Crohn’s disease,
illnesses, and injuries can cause
A person may not notice a small amount of gastritis—inflammation and ulcers in
bleeding in the digestive tract. This type of the lining of the stomach.
bleeding is called occult bleeding. Simple
tests can detect occult blood in the stool. • Esophagitis. Gastroesophageal reflux
disease (GERD) is the most common
cause of esophagitis—inflammation and
ulcers in the lining of the esophagus. In
GERD, the muscle between the esopha­
gus and stomach fails to close properly,
allowing food and stomach juices to
flow back into the esophagus.
• Benign tumors and cancer. A benign
tumor is an abnormal tissue growth that
is not cancerous. Benign tumors and
cancer in the esophagus, stomach, or
duodenum may cause bleeding.

2 Bleeding in the Digestive Tract

Causes of bleeding in the lower digestive How is bleeding in the
tract include the following:
digestive tract diagnosed?
• Diverticular disease. This disease is The first step in diagnosing bleeding in the
caused by diverticula—pouches in the digestive tract is locating the site of the
colon wall. bleeding. The doctor will take the patient’s
• Colitis. Infections, diseases such as complete medical history and perform a
Crohn’s disease, lack of blood flow physical examination. Symptoms such as
to the colon, and radiation can cause changes in bowel habits, black or red stools,
colitis—inflammation of the colon. and pain or tenderness in the abdomen may
tell the doctor which area of the digestive
• Hemorrhoids or fissures. Hemorrhoids tract is bleeding.
are enlarged veins in the anus or rectum
that can rupture and bleed. Fissures, or The doctor may need to test the stool for
ulcers, are cuts or tears in the anal area. blood. Iron supplements, bismuth subsalicy­
late (Pepto-Bismol), or certain foods such as
• Angiodysplasia. Aging causes
beets can give the stool the same appearance
angiodysplasia—abnormalities in the
as bleeding from the digestive tract. Stool
blood vessels of the intestine.
tests can also show bleeding that is not visible
• Polyps or cancer. Benign growths or to the patient.
polyps in the colon are common and
may lead to cancer. Colorectal cancer A blood test can help determine the extent
is the third most common cancer in the of the bleeding and whether the patient is
United States and often causes occult anemic.
bleeding.1 Nasogastric lavage is a procedure that can
be used to determine whether the bleeding
is in the upper or lower digestive tract. With
nasogastric lavage, a tube is inserted through
the nose and into the stomach. The con­
tents of the stomach are removed through
the tube. If the stomach contains bile and
does not contain blood, the bleeding either
has stopped or is likely in the lower digestive
tract.

1Common cancer types. National Cancer

Institute website. www.cancer.gov/cancertopics/

commoncancers#1. Updated May 7, 2009. Accessed

October 26, 2009.

3 Bleeding in the Digestive Tract

Endoscopy
Other Procedures
Endoscopy is the most common method for Several other methods can help locate the
finding the source of bleeding in the digestive source of bleeding:
tract. An endoscope is a flexible tube with a
• Barium x rays. Barium is a contrast
small camera on the end. The doctor inserts
material that makes the digestive tract
the endoscope through the patient’s mouth
visible in an x ray. A liquid containing
to view the esophagus, stomach, and duode­
barium is either swallowed or inserted
num. This examination is called esophago­
into the rectum. Barium x rays are less
gastroduodenoscopy (EGD). An endoscope
accurate than endoscopy and may inter­
can also be inserted through the rectum to
fere with other diagnostic techniques.
view the colon. This procedure is called
colonoscopy. The doctor can use the endo­ • Radionuclide scanning. The doctor
scope to do a biopsy, which involves collect­ injects small amounts of radioactive
ing small samples of tissue for examination material into the person’s vein. A spe­
with a microscope. cial camera, similar to an x-ray machine,
can detect this radiation and create
Bleeding that cannot be found with endos­
images of blood flow in the digestive
copy is called obscure bleeding. The doc­
tract. Radionuclide scanning is sensitive
tor may repeat the endoscopy or use other
enough to detect very slow bleeding, but
procedures to find the cause of obscure
it is not as accurate as other procedures.
bleeding.
• Angiography. A dye is injected into
Enteroscopy the person’s vein to make blood ves­
Enteroscopy is an examination of the small sels visible in x-ray or computerized
intestine. Because traditional endoscopes tomography (CT) scans. Dye leaks
cannot reach the small intestine, special out of the blood vessels at the bleeding
endoscopes are used for enteroscopy. site. In some cases, the doctor can use
angiography to inject medicine or other
Enteroscopy procedures include material into blood vessels to try to stop
• Push enteroscopy. A long endoscope the bleeding.
is used to examine the upper portion of • Exploratory laparotomy. If other
the small intestine. methods cannot locate the source of the
• Double-balloon enteroscopy. Balloons bleeding, a surgical procedure may be
are mounted on the endoscope to help necessary to examine the digestive tract.
the endoscope move through the entire
small intestine.
• Capsule endoscopy. The person swal­
lows a capsule containing a tiny camera.
The camera transmits images to a video
monitor as the capsule passes through
the digestive tract. This procedure is
designed to examine the small intestine,
but it also allows the doctor to examine
the rest of the digestive tract.

4 Bleeding in the Digestive Tract

How is bleeding in the
digestive tract treated? Points to Remember
Endoscopy can be used to stop bleeding in • Bleeding in the digestive tract is a
the digestive tract. A doctor can insert tools symptom of a disease rather than a
through the endoscope to disease itself.

• inject chemicals into the bleeding site • A number of different conditions

can cause bleeding in the digestive
• treat the bleeding site and surrounding tract.
tissue with a heat probe, electric cur­
rent, or laser • Finding the location and cause of
the bleeding is important.
• close affected blood vessels with a band
or clip • Most causes of bleeding can be

cured or controlled.

Endoscopy does not always control bleeding.

Angiography can be used to inject medi­ • Endoscopy is the most common tool
cine or other material into blood vessels to for diagnosing and treating bleeding
control some types of bleeding. If endoscopy in the digestive tract.
and angiography do not work, the patient
may need other treatments or surgery to stop
the bleeding.
Hope through Research
To prevent bleeding in the future, doctors
can treat the conditions that cause bleeding, The National Institute of Diabetes and
such as Digestive and Kidney Diseases (NIDDK)
sponsors research to improve treatment for
• H. pylori and other infections patients with digestive diseases that cause
• GERD bleeding in the digestive tract, including
diverticular disease, GERD, and inflamma­
• ulcers tory bowel diseases.
• hemorrhoids Participants in clinical trials can play a more
• polyps active role in their own health care, gain
access to new research treatments before
• inflammatory bowel diseases
they are widely available, and help others
by contributing to medical research. For
information about current studies, visit
www.ClinicalTrials.gov.

5 Bleeding in the Digestive Tract

For More Information National Digestive Diseases
American College of Gastroenterology Information Clearinghouse
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Fax: 301–654–5920 National Institute of Diabetes and Digestive
Email: [email protected] and Kidney Diseases (NIDDK). The
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Health of the U.S. Department of Health
Acknowledgments and Human Services. Established in 1980,
Publications produced by the Clearinghouse the Clearinghouse provides information
are carefully reviewed by both NIDDK about digestive diseases to people with
scientists and outside experts. This publica­ digestive disorders and to their families,
tion was reviewed by David A. Peura, M.D., health care professionals, and the public.
University of Virginia Health System. The NDDIC answers inquiries, develops and
distributes publications, and works closely
with professional and patient organizations
and Government agencies to coordinate
You may also find additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov. resources about digestive diseases.
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U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES
National Institutes of Health

NIH Publication No. 10–1133

January 2010