Some Causes and Features of Gastrointestinal Bleeding
Cause* |
Common Features† |
Tests |
Upper digestive tract (indicated by vomiting blood or dark brown material) |
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Ulcers or erosions of the esophagus, stomach, or first part of the small intestine (duodenum) |
Pain that Painless ulcers can also cause bleeding |
Upper GI endoscopy (examination of esophagus, stomach, and duodenum using a flexible viewing tube called an endoscope) |
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Esophageal varices (enlarged veins in the esophagus) |
Usually very heavy bleeding Often in people known to have chronic liver disease such as cirrhosis Sometimes signs of chronic liver disease such as a swollen abdomen and yellowish discoloration of the skin and whites of the eyes (jaundice) |
Upper GI endoscopy |
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Mallory-Weiss tear (a tear in the esophagus caused by vomiting) |
In people who vomited one or more times before they started vomiting blood Sometimes pain in the lower chest during vomiting |
Upper GI endoscopy |
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Abnormal connections between the arteries and veins (arteriovenous malformations) in the intestine |
Usually no other symptoms |
Upper GI endoscopy |
Lower digestive tract (indicated by passing blood in the stool) |
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Bright red blood only on toilet paper, dripping in the bowl, or on the surface of formed stools |
Anoscopy (examination of the anus and rectum with a short, rigid tube) or sigmoidoscopy |
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Pain during bowel movements Bright red blood only on toilet paper or on the surface of formed stools Fissure seen during the doctor's examination |
A doctor’s examination |
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Abnormal blood vessels (angiodysplasia) in the intestine |
Painless, bright red blood from the rectum (hematochezia) Usually in people over age 60 (most common cause of large intestine bleeding in this age group) |
Colonoscopy (examination of the entire large intestine, rectum, and anus using an endoscope) |
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Inflammation of the large intestine due to radiation therapy, infection, or disruption of the blood supply (as occurs in ischemic colitis) |
Bloody diarrhea, fever, and abdominal pain |
Colonoscopy Stool tests to look for infectious organisms Sometimes CT scan |
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Sometimes fatigue, weakness, and/or a bloating sensation Usually in middle-aged or older people |
Colonoscopy and biopsy (examination of tissue samples taken from the lining of the intestine) |
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Often no other symptoms |
Colonoscopy |
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Diverticular disease (such as diverticulosis) |
Painless hematochezia Sometimes in people already known to have diverticular disease |
Colonoscopy Sometimes CT scan or CT angiography Rarely angiography (x-rays taken after injecting a dye into an artery using a catheter) |
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Inflammatory bowel disease (such as ulcerative proctitis, ulcerative colitis, or Crohn disease) |
Bloody diarrhea, fever, and abdominal pain and cramps Sometimes in people who have had several episodes of bleeding from the rectum |
Colonoscopy and biopsy |
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* Causes are listed in order from the most common to the least. |
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† Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. |
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CT = computed tomography; GI = gastrointestinal. |
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