Gastrointestinal (GI) bleeding is a symptom of a disorder in your digestive tract. The blood often appears in stool or vomit but isn't always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and life-threatening.

Bleeding in the stomach or colon can usually be easily identified, but finding the cause of bleeding that occurs in the small intestine can be difficult. But sophisticated imaging technology can usually locate the problem, and minimally invasive procedures often can fix it.

GI bleeding can result from a number of digestive disorders, including:

GI bleeding can be visible in the form of vomiting blood, having bright red bloody stools or having black tarry stools (melena). Even a small amount of GI bleeding that isn't visible can cause a shortage of red blood cells in your blood (anemia) over time.

Pinpointing the source of GI bleeding can be especially difficult if it starts in the small intestine. When the source can't be identified, the term "obscure GI bleeding" is used.

  • Diagnostic expertise. State-of-the-art imaging, some of it developed at Mayo Clinic, helps Mayo Clinic doctors find the cause of your GI bleeding. Mayo Clinic doctors treat more than 2,500 people each year for GI bleeding.
  • Advanced treatments. Mayo Clinic doctors have experience using the latest techniques to repair your GI bleeding. Treatment is tailored to your specific needs.

Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for digestive disorders.

Mayo Clinic doctors start by asking you about your symptoms and by doing a thorough physical examination and blood tests. This initial exam may be enough to indicate a cause of GI bleeding.

But if the source isn't obvious, Mayo Clinic doctors can use sensitive imaging technologies to find it. Results from one procedure determine the next procedure to use until the cause is determined.

Mayo doctors use these tests:

  • Upper endoscopy. This procedure — also called esophagogastroduodenoscopy — uses a scope to inspect your esophagus and stomach, as well as the upper part of your small intestine (duodenum). The doctor may remove a small tissue sample (biopsy) for further study and in some cases control or treat the bleeding source.
  • Colonoscopy. This test uses a long, flexible tube to provide video images of your rectum and colon. In some cases, bleeding can be controlled or treated during a colonoscopy.
  • Capsule endoscopy. You swallow a small pill containing a video camera, which transmits images of your small intestine to a recording device.
  • Balloon-assisted enteroscopy. A specialized scope inspects parts of your small intestine that esophagogastroduodenoscopy and colonoscopy can't reach. Sometimes, the source of bleeding can be controlled or treated during this test.
  • Endoscopic ultrasound. An ultrasound probe attached to an endoscope allows doctors to see all the layers of tissue in the digestive tract.
  • Endoscopic retrograde cholangiopancreatography (ERCP). A scope combined with an X-ray procedure allows doctors to see the ducts of the gallbladder, liver and pancreas. However, this test is rarely needed in the evaluation of GI bleeding.
  • Multiphase CT enterography or magnetic resonance (MR) enterography. Mayo Clinic researchers helped develop these noninvasive radiologic tests, which are more sensitive than conventional X-rays for finding the source of GI bleeding. These tests can provide images of the entire thickness of the bowel wall, all of the long loops in the small intestine and all layers of surrounding tissue.
  • Angiography. A contrast dye is injected into an artery, and a series of X-rays are taken to look for and treat bleeding vessels or other abnormalities.

If your GI bleeding is severe, and noninvasive tests can't find the source, you may need surgery so that doctors can view the entire small intestine. Fortunately, this is rare.

Mayo Clinic specialists have a variety of treatment options that may be used in combination, depending on the source of your GI bleeding:

  • Endoscopic thermal probe. This treatment can stop bleeding from ulcers and other abnormalities by burning (coagulating) the blood vessel or abnormal tissue.
  • Endoscopic injection. With endoscopic injection, your doctor can stop the bleeding by injecting a liquid, such as diluted epinephrine, at the source of the bleeding.
  • Argon plasma coagulation and radiofrequency ablation are other types of thermal techniques used to treat abnormal blood vessels in the stomach, small intestine and colon.
  • Endoscopic clips can be used to close a bleeding vessel or other defective tissue.
  • Endoscopic band ligation uses special bands to treat bleeding hemorrhoids and bleeding blood vessels (varices) in the esophagus.
  • Endoscopic intravariceal cyanoacrylate injection uses a special glue to treat difficult bleeding from varices in the stomach.
  • Angiographic embolization injects particles directly into a blood vessel to stop bleeding.

If bleeding recurs after treatment, you may need a repeat evaluation and treatment. Although it's rare, you may need surgery.

Once the source of the bleeding is identified and stopped, the next step is to treat the condition that caused the bleeding in the first place.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Specialists in gastroenterology usually manage care for adults who have GI bleeding.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology usually manage care for adults who have GI bleeding.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology usually manage care for children and adults who have GI bleeding.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic researchers are working on improved imaging technology to find the source of GI bleeding. Mayo radiologists were instrumental in developing novel imaging techniques for bowel disorders that can help pinpoint the location of GI bleeding. Mayo doctors also are researching new techniques for treating GI bleeding.


See a list of publications by Mayo authors on gastrointestinal bleeding on PubMed, a service of the National Library of Medicine.

Oct. 21, 2015