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<p><span style="color: #00826a;">When there is bleeding, we often think of accidents that occur on the external skin. But did you know that internal organs can also bleed, especially bleeding in the gastrointestinal tract, which many people do not expect?</span> Gastrointestinal bleeding can occur for many reasons. Sometimes it is not life-threatening, but in some cases, it can be fatal. Common causes of bleeding are generally controllable, such as hemorrhoids, which is just one example. The human gastrointestinal tract consists of the esophagus, stomach, small intestine, large intestine, and rectum, where bleeding can occur without us knowing.</p>
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<h4><span style="background-color: #ffffff; color: #00826a;">How does bleeding occur in the gastrointestinal tract?</span></h4>
<p>The causes must be divided into upper gastrointestinal tract (esophagus, stomach, and proximal small intestine). The causes are often due to increased stomach acid, Helicobacter pylori infection, or the use of painkillers and blood thinners, especially Aspirin, which can cause inflammation or ulcers in the stomach and small intestine. Increased acid in the stomach may reflux into the esophagus, causing inflammation or ulcers as well, especially in people whose lower esophageal sphincter does not contract properly. Other causes include varices in the esophagus and stomach, tumors or cancers of the upper gastrointestinal tract, and esophageal tears from severe retching and vomiting, etc.</p>
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<p>As for causes of bleeding in the lower gastrointestinal tract, there are many causes ranging from hemorrhoids, bleeding from diverticula in the large intestine, small intestine → large intestine, abnormally dilated blood vessels in the intestinal mucosa, intestinal ulcers, as well as tumors and cancers.</p>
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<h4><span style="background-color: #ffffff; color: #00826a;">Which organs in the gastrointestinal tract commonly have bleeding?</span></h4>
<ul>
<li>Upper gastrointestinal tract: bleeding most commonly occurs from ulcers in the proximal small intestine and stomach.</li>
<li>Lower gastrointestinal tract: bleeding most commonly occurs from hemorrhoids, followed by the large intestine.</li>
</ul>
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<h4><span style="background-color: #ffffff; color: #00826a;">How to know if there is bleeding?</span></h4>
<p>The location and severity: If bleeding is from the lower large intestine or rectum, it is usually bright red blood mixed with stool or dripping after defecation. If bleeding is from the large intestine or distal small intestine, the stool may appear black mixed with red. If bleeding is from the esophagus, stomach, or proximal small intestine, the stool will be black, and there may be vomiting of red or black coffee-ground-like material. Regarding severity, if bleeding is severe, the stool can be red regardless of the bleeding site in the gastrointestinal tract. If bleeding is small or slow, it may not be visible to the naked eye and requires special tests to detect blood. Other symptoms may include fatigue, dizziness, fainting, especially if the patient&#8217;s blood hemoglobin level drops significantly.</p>
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<p>History taking and physical examination help indicate the likely bleeding site in the gastrointestinal tract, leading to diagnosis, cause identification, and appropriate treatment.</p>
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<h4><span style="background-color: #ffffff; color: #00826a;"><strong>Endoscopy</strong></span></h4>
<p>Endoscopy can identify the bleeding site and stop active bleeding. The endoscope is a flexible tube that can be inserted through the mouth or rectum, allowing the doctor to see the esophagus, stomach, and small intestine (Esophagogastroduodenoscopy), large intestine (Colonoscopy), and distal large intestine (Sigmoidoscopy). It can also collect tissue samples (Biopsies), take pictures, and stop bleeding.</p>
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<h4><span style="background-color: #ffffff; color: #00826a;">Other diagnostic methods</span></h4>
<ul>
<li>Barium swallow or enema X-ray can indicate the bleeding site but is not as effective as endoscopy. Barium can interfere with other tests as it remains in the intestines.</li>
<li>X-rays cannot obtain tissue samples or stop bleeding.</li>
<li>Angiography involves injecting dye into the blood vessels to detect leakage sites, helping locate bleeding. This method can also be used therapeutically by injecting medication to stop bleeding.</li>
<li>Radionuclide scanning detects bleeding sites in cases of slow bleeding.</li>
</ul>
<h4><span style="background-color: #ffffff; color: #00826a;">Treatment of bleeding</span></h4>
<p>Endoscopy can identify the cause and provide treatment, especially during active bleeding, such as injecting medication through the endoscope, applying heat to cauterize the bleeding site, clipping blood vessels, or using rubber bands to ligate blood vessels.<br />
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<p><span style="font-size: 16x;">Additionally, some medications may be given to reduce risk, promote faster healing of ulcers, and eradication of Helicobacter pylori infection to reduce the risk of recurrent ulcers.</span></p>
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<p>In cases of bleeding from hemorrhoids, treatment may include rubber band ligation, injection, or electrocautery. However, if endoscopic treatment fails to stop bleeding or bleeding recurs, other treatments such as angiographic embolization or surgery may be necessary.</p>
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<p><span style="color: #00826a;"><em><span style="background-color: #ffffff;">Maintaining good health, eating on time, and paying attention to both external and internal conditions, observing any abnormalities in the body regularly, and not neglecting any symptoms are important because even minor symptoms can lead to serious, life-threatening problems.</span></em></span></p>
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<div style="text-align: right;"><span style="color: #4a7b8c;"> </span></div>
<div style="text-align: right;"><span style="color: #4a7b8c;"> </span></div>
<div style="text-align: right;"><span style="color: #00826a;"><strong>Dr. Wiriya Tanyawalak</strong></span></div>
<div style="text-align: right;">Gastroenterologist</div>
<div style="text-align: right;">Center for Gastrointestinal Endoscopy and Liver Diseases</div>
<div style="text-align: right;">Phyathai 3 Hospital</div>


Internal organs can also experience bleeding, especially bleeding in the gastrointestinal tract. The causes vary depending on the organ, such as the upper gastrointestinal tract and the lower gastrointestinal tract. The cause can be identified through endoscopic examination.

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The digestive tract can also bleed.

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