Bleeding in the gastrointestinal (GI) tract can stem from several causes that affect any of the organs in the upper digestive system. An upper GI bleed is bleeding in the mouth, esophagus (food tube), stomach, or small intestine.
Bleeding in the digestive system isn't a condition by itself but rather a sign of a disorder. Depending on the cause, an upper GI bleed can be serious. Each year in the United States, about 100,000 people seek care from a hospital for an upper GI bleed.
This article describes upper GI bleeds, including causes, treatment options, and when to seek out emergency medical care.
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What Is an Upper GI Bleed?
An upper GI bleed is bleeding from an organ in the upper digestive system, which includes the mouth, esophagus, stomach, and small intestine.
A GI bleed can be characterized as acute or chronic. Acute means that it starts suddenly and can be severe.Chronic means it's less significant bleeding that continues long term and may be intermittent (meaning that it comes and goes). Upper GI bleeds are more common in men than they are in women.
A Note on Gender and Sex Terminology
Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Upper GI Bleed Symptoms
Symptoms may not be noted for some causes of an upper GI bleed. If there are symptoms, they could include:
- Black, tarry stools
- Bleeding that may be heavy if it is from the esophagus
- Blood in or on the stool
- Pain below the breastbone that can interrupt sleep and may feel better after eating
- Pain that is mild to moderately severe
- Vomiting blood or substance that looks like coffee grounds
Other symptoms may be noted based on the cause of the bleeding.
When to Contact a Healthcare Provider
If you suspect bleeding in the upper digestive tract, seek care from a healthcare provider. Any blood in vomit or stool is a reason to make an appointment to be seen as soon as possible. Significant amounts of blood should be evaluated right away in a hospital emergency department.
Symptoms that could mean that the bleeding is serious include:
- Feeling faint or fainting
- Blood of more than a cup in vomit or stool
- Rapid heartbeat
What Causes an Upper GI Bleed
Many conditions could cause a bleed in the upper digestive system. They vary in severity and treatment.
Peptic Ulcer
A peptic ulcer is a hole or a sore in the stomach or the first section of the small intestine (the duodenum).
Most often, this is caused by the bacterium Helicobacter pylori (H. pylori). In some cases, it may also be from the use of over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs). This includes aspirin, Advil or Motrin (ibuprofen), and Aleve (naproxen).
A peptic ulcer may cause symptoms of:
- Belching (burping)
- Bloating
- Feeling full quickly when eating
- Feeling uncomfortable after meals
- Nausea
- Pain or discomfort in the upper abdomen
- Vomiting
Esophagitis
Esophagitis is an inflammation in the esophagus. Some of the reasons for esophagitis include allergies, hiatal hernia (the upper part of the stomach bulges through the diaphragm), medications, supplements, infections, or after receiving radiation therapy.
Esophagitis may cause symptoms such as:
- Abdominal pain
- Chest pain (which could be confused with chest pain caused by a heart attack)
- Cough
- Difficulty swallowing food or liquids
- Fever
- Heartburn
- Nausea
- Pain when swallowing
- Vomiting
Enteritis
Enteritis is when the small intestine is inflamed. Some causes include infection, certain medications (such as NSAIDs), radiation treatments, or a chronic condition (including Crohn’s disease or celiac disease).
Enteritis may cause symptoms that include:
- Abdominal pain
- Bloating
- Diarrhea, which could include blood or mucus
- Fatigue
- Nausea
- Urgency to move the bowels
Mallory-Weiss Tears
Mallory-Weiss syndrome is a tear in the esophagus that bleeds. It is usually caused by forceful vomiting, retching, or hiccuping. It typically stops on its own, except in the 10% of cases in which the bleeding is severe. In this situation, there may be a need for treatment in the hospital and/or a blood transfusion.
Esophageal Varices
Esophageal varices are swollen veins in the lower part of the esophagus. They are most often associated with scarring in the liver (cirrhosis), which causes a complication called portal hypertension. If one of these veins breaks open, it can cause bleeding that may be life-threatening.
Gastritis
Gastritis is inflammation of the stomach lining. The most common cause is an H. pylori infection. Gastritis may come on suddenly or become chronic.
Gastritis might not cause any symptoms. If there are symptoms, however, these can include:
- Feeling full quickly while eating
- Feeling uncomfortably full after a meal
- Lack of appetite
- Nausea
- Pain or discomfort in the upper abdomen
- Weight loss
- Vomiting
Cancer
Tumors in the stomach, small intestine, or esophagus may also cause bleeding. These types of tumors could be benign (noncancerous) or they could be malignant (cancerous).
In some cases they might not cause any symptoms and are found when there is testing for another reason. Some types of cancer in the upper digestive system are related to the use of alcohol and tobacco.
How Is an Upper GI Bleed Diagnosed?
Various tests may be used to find the source of bleeding in the digestive tract. A healthcare provider will start by asking questions about symptoms and family history. A physical exam will also be used to understand more about what could be causing symptoms.
Some of the tests that may be used include:
- Abdominal computed tomography (CT) scan, which creates an image of the digestive system through a series of X-rays
- Angiography, which is used to examine the blood vessels for abnormalities
- Blood tests to look for anemia or other signs of disease
- Gastric lavage, which is a test that is used to take a sample of the stomach contents for testing
- Endoscopy procedures, which are used to look inside the esophagus, stomach, and first part of the small intestine
- Radionuclide scan, which uses a small amount of radioactive material injected into the blood and is tracked through the body
- Upper GI series, which uses X-rays and a contrast liquid to see the organs of the digestive system better
- Stool tests to look for the presence of blood or an infection
Treatment Options
Treatment for upper GI bleeding will depend on the cause. Once the cause is found, healthcare providers will come up with a treatment plan that may include:
- Medication: Infection or inflammation may be treated with drugs and/or supplements.
- Procedures: Some of the tests that diagnose bleeding might can also be used to administer treatment by injecting medication or using a tool to stop the source of the bleeding.
- Surgery: In some cases, the cause of the bleeding may require surgery, such as a tumor or when there is severe bleeding.
Who’s at Risk for an Upper GI Bleed?
Risk factors for bleeding in the upper GI tract include:
- Age over 50 years, and especially over the age of 70 years
- Having a previous GI bleed
- Infection with H. pylori
- Male sex
- Use of medications such as NSAIDs, antiplatelet medications, and anticoagulants
Can an Upper GI Bleed Be Prevented?
It may not be possible to prevent all possible causes of upper GI bleeding. Managing any conditions that are affecting the mouth, esophagus, stomach, or small intestine will be an important part of avoiding the potential for bleeding.
Other lifestyle changes that may help reduce the potential causes of bleeding include limiting the use of NSAIDs, stopping smoking, drinking alcohol only in moderation or not at all, and working with a healthcare provider to treat any conditions of the digestive system.
Summary
Upper GI bleeding can be caused by many common conditions, including peptic ulcer, esophagitis, enteritis, gastritis, and esophageal varices. The bleeding and its underlying condition may be easily treatable or life-threatening.
Any sign or symptom of upper GI bleeding is a reason to contact a healthcare provider. If there are symptoms such as bleeding that won't stop, fainting, dizziness, severe pain, or trouble breathing, seek care in a hospital emergency department.
