How to Treat Upper Gastrointestinal Bleeding

Explore this Article

parts

1Recognizing the Signs Stabilizing Vital Signs

2Investigating Further

3Treating the Underlying Cause of the Bleeding

Other Sections

Related Articles

References

If you suspect you have internal bleeding, seek immediate emergency medical care. When you have an upper GI bleed, the first step in treatment is to stabilize your vital signs. This is because, in cases of severe bleeding, you are at risk of potentially going into shock from significant blood loss. Once you have been stabilized, your doctor will perform tests to diagnose the specific cause of your upper GI bleed, so that the underlying cause can be treated appropriately. Most often, the treatment is done endoscopically.

Steps

Part 1

Part 1 of 3:

Recognizing the Signs Stabilizing Vital Signs

1. 1
   Know the signs and symptoms of upper gastrointestinal bleeding. The signs of upper GI bleeding can be scary — one of the most common indicators is vomiting blood. Don't panic — call your doctor and get immediate attention if you experience the following:

   • Vomiting blood, which may resemble coffee grounds
   • Black stools with a foul odor
   • Fresh blood passing through the anus, usually found with stool (this is more likely to indicate lower GI bleeding, but may still be present with upper GI bleeding)
   • Feeling faint and lightheaded, weak
   • Pain in the upper abdomen, just below the ribs
   • Heartburn or indigestion
2. 
   2
   Have your vital signs tested. Depending upon the degree of bleeding, an upper GI bleed can, in some cases, be life-threatening. If you are losing blood at a rapid rate, the amount of blood left to circulate through your body decreases, which can lead to lightheadedness, paleness, fainting, and ultimately signs of shock from blood loss. Your doctor can test your vital signs to get an idea of how much blood you have lost. Signs pointing toward more severe blood loss include:

   • An abnormally rapid heart rate
   • An abnormally low blood pressure
   • An increased respiratory rate
   • A decreased level of consciousness
   Advertisement
3. 
   3
   Receive blood tests and assess for anemia. One of the key factors to assess in a GI bleed is the degree of blood loss. In cases of severe blood loss, the key will be to replace the lost blood and stabilize you medically before moving onto specific diagnosis and treatment options. If you are only losing minimal blood, however, your doctor can proceed straight to diagnosis and treatment.

   • The best way to assess the degree of blood loss, if it is uncertain (i.e. assuming you are not in shock or showing other clinical signs of blood loss), is through a blood test.
   • The blood test will check your hemoglobin levels, which is the molecule in your blood that is responsible for carrying oxygen.
   • Low hemoglobin is diagnostic of "anemia," and the severity of the anemia correlates to the degree of blood lost from the GI bleed.
4. 
   4
   Receive fluids or a blood transfusion, if needed. After determining your degree of blood loss (through a combination of clinical signs and a blood test for anemia), your doctor will offer you IV fluids and/or a blood transfusion if he or she determines that your blood volume is sufficiently low and needs to be replenished.

   • IV fluids are given in cases of less severe blood loss. They boost your blood volume (the amount of fluid traveling in your circulatory system), but do not directly increase the hemoglobin (or functional oxygen-carrying capacity) of your blood.
   • If your hemoglobin is substantially decreased (i.e. if you have very severe anemia leading to functional compromise of your cardiorespiratory system), you may need a blood transfusion.
   Advertisement

Part 2

Part 2 of 3:

Investigating Further

1. 
   1
   Ask your doctor for PPIs (proton pump inhibitors). PPIs are medications that can help to decrease the severity of upper GI bleeding. Even before the cause of the bleed is identified, it is recommended to receive PPIs as having them in your system decreases the chances that you will need an endoscopic repair, once the source of bleeding is identified.
2. 
   2
   Opt for gastric lavage. Prior to receiving an endoscopy, it is sometimes helpful to receive a "gastric lavage." This is where the contents of the stomach — including possible blood pooling — are washed away to allow a clearer view of the stomach wall on endoscopic examination.

   • This allows for easier identification of the source of the upper GI bleed.
   • It also allows for a clearer view to aid in treatment of the GI bleed (which depends upon having a view to identify the source of the bleed).
3. 
   3
   Receive an upper GI endoscopy. Once you have been stabilized medically, if needed (i.e. if your vital signs were compromised or your degree of blood loss was severe enough to warrant fluids and/or a transfusion), the next step will be for your doctor to determine the underlying diagnosis — that is, the cause of your GI bleed. Determining the cause will be what dictates the ultimate treatment plan.

   • An upper GI endoscopy is usually recommended as a diagnostic evaluation within the first 24 hours of the bleed (if possible).
   • An upper GI endoscopy is when a tube with a camera on the end is inserted down your throat, through your esophagus, and ultimately down to your stomach.
   • The purpose is to visually assess (via the camera) for the source of the GI bleeding.
   • Treatments may also be given endoscopically if and when the source of the bleeding is identified.
4. 
   4
   Identify the cause of the bleeding. The most common cause of upper GI bleeding is peptic ulcers (ulcers in the stomach). These account for 60% of upper GI bleeds. They are more prevalent in individuals who have active H. Pylori infection in their stomachs, so offering antibiotic treatment for this bacteria may be part of the advised treatment plan. What accounts for the other 40% of upper GI bleeds? If you are not diagnosed with a peptic ulcer(s), your doctor will consider the following sources of possible upper GI bleeding:

   • Mallory-Weiss tears — these are tears in your esophagus, often caused by extreme force such as forceful retching or vomiting leading to rupture of esophageal blood vessels.
   • Esophageal varices — these are delicate blood vessels in the esophagus that may rupture and bleed.
   • Arteriovenous malformations — these are genetic abnormalities of the blood vessels predisposing a person to bleeding in the area of the malformation.
   • Cancer (such as stomach/esophageal/intestinal cancer) — the delicate blood vessels of cancerous growths are highly susceptible to bleeding.
   • Gastritis — this is abnormal inflammation and irritation of the stomach lining, which may lead to blood loss.
   • Duodenitis — this is abnormal inflammation and irritation of the duodenum in the small intestine, which may also lead to blood loss.
   Advertisement

Part 3

Part 3 of 3:

Treating the Underlying Cause of the Bleeding

1. 
   1
   Have the source of the bleed treated endoscopically. When the upper GI endoscope is inserted to look for the source of the bleed, it can also be used to administer treatment at the site of bleeding once that location is found. Types of treatment that can be offered endoscopically include:

   • Injection of epinephrine
   • Thermocoagulation
   • Banding
   • Application of clips
   • Studies have shown that the combination of an epinephrine injection with another form of treatment for the bleed is the most successful at stopping the bleeding and preventing recurrences.
2. 
   2
   Stop any medications that may worsen the GI bleed. While medical treatment is not the mainstay of treating an upper GI bleed, removing any medications that you may be on that could make the situation worse is key. Medications that may exacerbate (or predispose you to) GI bleeding include:

   • Blood thinning medications such as Warfarin (Coumadin) or others, which disrupt your natural clotting cascade and hence worsen any existing bleeds. Talk to your doctor about temporarily stopping these medications until your GI bleed is resolved or if you need to stop them permanently.
   • NSAIDs such as Ibuprofen (Advil, Motrin), because in many cases these cause upper GI bleeds. Therefore, if you are taking one regularly, consider stopping it and/or replacing it with a different medication.
   • Aspirin, which interrupts platelet aggregation and hence worsens any existing bleeds. Talk to your doctor about temporarily stopping this medication until your GI bleed is resolved.
3. 
   3
   Treat recurrent GI bleeds as needed. It is important to understand that 10-20% of treated upper GI bleeds recur. That is, the treatment does not last long-term. In cases of recurrence, physicians are advised to try a second attempt at the same endoscopic therapy tried the first time. If this fails again, and the bleed recurs for a third time, physicians are advised to proceed with "arteriography with embolization," or with surgery.
   Advertisement

Expert Q&A

Search

Add New Question

Ask a Question

200 characters left

Include your email address to get a message when this question is answered.

Submit

Advertisement