Diagnosis

Your doctor will take a medical history, including a history of previous bleeding, conduct a physical exam and possibly order tests. Tests might include:

  • Blood tests. You may need a complete blood count, a test to see how fast your blood clots, a platelet count and liver function tests.
  • Stool tests. Analyzing your stool can help determine the cause of occult bleeding.
  • Nasogastric lavage. A tube is passed through your nose into your stomach to remove your stomach contents. This might help determine the source of your bleed.
  • Upper endoscopy. This procedure uses a tiny camera on the end of a long tube, which is passed through your mouth to enable your doctor to examine your upper gastrointestinal tract.
  • Colonoscopy. This procedure uses a tiny camera on the end of a long tube, which is passed through your rectum to enable your doctor to examine your large intestine and rectum.
  • Capsule endoscopy. In this procedure, you swallow a vitamin-size capsule with a tiny camera inside. The capsule travels through your digestive tract taking thousands of pictures that are sent to a recorder you wear on a belt around your waist. This enables your doctor to see inside your small intestine.
  • Flexible sigmoidoscopy. A tube with a light and camera is placed in your rectum to look at your rectum and the last part of the large intestine that leads to your rectum (sigmoid colon).
  • Balloon-assisted enteroscopy. A specialized scope inspects parts of your small intestine that other tests using an endoscope can't reach. Sometimes, the source of bleeding can be controlled or treated during this test.
  • 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.
  • Imaging tests. A variety of other imaging tests, such as an abdominal CT scan, might be used to find the source of the bleed.

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

Treatment

Often, GI bleeding stops on its own. If it doesn't, treatment depends on where the bleed is from. In many cases, medication or a procedure to control the bleeding can be given during some tests. For example, it's sometimes possible to treat a bleeding peptic ulcer during an upper endoscopy or to remove polyps during a colonoscopy.

If you have an upper GI bleed, you might be given an IV drug known as a proton pump inhibitor (PPI) to suppress stomach acid production. Once the source of the bleeding is identified, your doctor will determine whether you need to continue taking a PPI.

Depending on the amount of blood loss and whether you continue to bleed, you might require fluids through a needle (IV) and, possibly, blood transfusions. If you take blood-thinning medications, including aspirin or nonsteroidal anti-inflammatory medications, you might need to stop.

Preparing for your appointment

If your bleeding is not severe, you might start by seeing your primary care provider. Or you might be referred immediately to a specialist in gastrointestinal disorders (gastroenterologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment and when they began
  • All medications, vitamins or other supplements you take, including doses
  • History of digestive disease you've been diagnosed with, such as GERD, peptic ulcers or IBD
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For gastrointestinal bleeding, basic questions to ask your doctor include:

  • I'm not seeing blood, so why do you suspect a GI bleed?
  • What's likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them while my bleeding is treated?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you take non-steroidal anti-inflammatory medication, either over-the –counter or prescribed, or do you take aspirin?
  • Do you drink alcohol?

Gastrointestinal bleeding care at Mayo Clinic

Sept. 21, 2018
References
  1. Jameson JL, et al., eds. Gastrointestinal bleeding. In: Harrison's Principles of Internal Medicine. 20th ed. New York, N.Y.: The McGraw-Hill Companies; 2018. https://accessmedicine.mhmedical.com. Accessed Aug. 28, 2018.
  2. Overview of GI bleeding. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/gi-bleeding/overview-of-gi-bleeding. Accessed Aug. 28, 2018.
  3. Strate L, et al. ACG clinical guidelines: Management of patients with acute lower gastrointestinal bleeding. American Journal of Gastroenterology. 2016;111:459.
  4. Definitions and facts of GI bleeding. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding/. Accessed Aug. 23, 2018.
  5. Strate L. Approach to acute lower gastrointestinal bleeding in adults. https://www.uptodate.com/contents/search. Accessed Aug. 23, 2018.
  6. Saltzman JR. Approach to acute upper gastrointestinal bleeding in adults. https://www.uptodate.com/contents/search. Accessed Aug. 23, 2018.
  7. Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Aug. 14, 2018.
  8. AskMayoExpert. Testing following normal upper endoscopy and colonoscopy (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  9. Small bowel bleeding. American College of Gastroenterology. http://patients.gi.org/topics/small-bowel-bleeding/. Accessed Aug. 23, 2018.