The many causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their location in the GI tract.
Upper GI Bleeding
Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-the esophagus, stomach, or duodenum (first part of the intestine). Blood from the upper GI tract can create a black tarry bowel movement. This may be the only indicator of bleeding and should prompt immediate call to your physician or visit to the emergency room. Most often, upper GI bleeding is caused by one of the following:
- Peptic ulcers: ingestion of Aspirin, NSAIDs (ibuprofen, naproxen, etc) and Helicobacter pylori are the most common causes of bleeding ulcers.
- Erosive Esophagitis (severe acid reflux)
- Stomach cancer or esophageal cancer
- Esophageal varices
- Mallory-Weiss tears
Esophagogastroduodenoscopy (EGD), commonly referred to as upper endoscopy, is a safe and minimally invasive procedure performed by all of our physicians that can easily detect the cause of upper GI bleeding. The bleeding can be treated during an EGD. Prompt evaluation with EGD has allowed for the vast majority of bleeding episodes to be effectively treated rapidly without need for surgery.
Lower GI Bleeding
Lower GI bleeding originates in the portions of the GI tract farther down the digestive system-the segment of the small intestine farther from the stomach, large intestine (colon), rectum, and anus. Diverticular disease, angiodysplasia (AVM), colonic polyps, hemorrhoids, and anal fissures most commonly cause the bleeding. Blood in the stool can result from colon cancer, inflammatory bowel disease, and infectious diarrhea.
Colonoscopy is the diagnostic procedure necessary to diagnose the cause of lower GI bleeding and treat the bleeding source. All of our physicians performs colonoscopy.
Obscure GI Bleeding
In about 5-10% of cases of GI bleeding, blood loss comes from a portion of the small intestine that is not within the reach of conventional EGD or colonoscopy. This is called obscure GI bleeding. Bleeding can be occult (only detected on stool cards) or overt (clear apparent blood loss from the digestive system). Sometimes occult bleeding manifests in laboratory results as iron deficiency anemia (low blood count from chronic iron loss). Iron deficiency anemia can be readily detected by routine lab testing often done as part of a general physical exam.
Wireless Capsule Endoscopy (commonly referred to as “Pill Camera”) has revolutionized the evaluation of patients with obscure GI bleeding. The capsule includes a video recorder, light source and transmitter, which can be swallowed and allow for 8 hours of video imaging of the digestive tract.
Our physicians perform capsule endoscopy within our office. Patients will swallow the capsule in the morning and wear a recording device during the day which records all video transmission from the wireless video camera within the capsule. The video is downloaded at the end of the day on to a computer in our office so our physicians can study the video. Appropriate treatment can then be performed based on the capsule results.