Bleeding can occur within any organ but internal bleeding tends to be more common in the gut. This includes the esophagus, stomach or intestines. It occurs when the inner wall of the gut is damaged and there is break within the blood vessels in the wall. The stomach is one of the commonly affected sites.
What is Gastric Bleeding?
Gastric bleeding is bleeding from the stomach wall. The blood leaks into the stomach cavity. There stomach wall has an extensive blood supply within it. Any factor that may compromise the integrity of the inner wall can result in bleeding. This can vary from tiny cuts and sores in the lining, bleeding ulcers to actual tears of the stomach wall. Stomach bleeding is also referred to as gastrorrhagia or a gastric hemorrhage.
Bleeding in the stomach does not always cause symptoms. A small bleed may remain undetected for long periods of time until it contributes to anemia, is detected during an endoscopy or trace amounts of blood are detected in the stool. With anemia and blood in the stool tests, there is no clear indication of where the bleed is occurring within the gut.
Any sign of upper gastrointestinal bleeding should be taken seriously and immediate medical treatment should be sought. Most cases of upper gastrointestinal bleeding (esophagus, stomach, duodenum) is a result of bleeding within the stomach. There are a host of causes of gastric (stomach) bleeding, some of which can be acute and may not require treatment, while others could be related to serious chronic conditions.
Stomach Bleeding Symptoms
Bleeding from the stomach can cause a host of signs and symptoms, some of which may clearly indicate a bleed while others can be vague and mistaken for other gastrointestinal conditions. Common signs and symptoms of stomach bleeding include :
- Vomiting of red, ‘fresh’ blood (hematemesis).
- Vomiting of ‘old’, brown to black blood which resembles coffee grounds.
- Presence of ‘fresh’ blood in the stool (hematochezia).
- Black tarry stool due to the presence of ‘old’ blood (melena).
- Epigastric pain (upper middle part of the abdomen, just below the breastbone) which may vary from sharp, stabbing pains to stomach cramps.
- Dizziness/lightheaded feeling.
Not all these signs and symptoms of stomach bleeding may be present. Blood in the vomit (hematemesis) is sufficient to make a differential diagnosis of upper gastrointestinal bleeding but it cannot be isolated to the stomach. It can also arise with bleeding from the esophagus or duodenum of the small intestine.
Other signs and symptoms of stomach bleeding includes :
- General abdominal pain.
- Fatigue and shortness of breath in chronic bleeding.
- Fainting if there is significant blood loss.
- Lack of appetite.
- Loss of weight in chronic cases.
- Smell and taste of blood. This is subjective but is sometimes reported by patients with upper gastrointestinal bleeding.
Dangers of Bleeding
Red flag signs that are considered a medical emergency.
- Low blood pressure (hypotension).
- High heart rate (tachycardia).
- Signs of shock in cases of significant blood loss.
Stomach Bleeding Causes
Gastric bleeding can be acute or chronic. Acute cases can be mild or severe possibly even leading to death if immediate medical treatment is not sought. Chronic stomach bleeding is usually mild, although there may be acute exacerbations. A clinical evaluation, including a case history, assessment of the signs and symptoms, blood tests and imaging studies will help to identify the site of the bleeding will assist with isolating the cause.
Gastric (Stomach) Ulcers
A bleeding stomach ulcer is the most common cause. It is an open sore that forms in the inner stomach wall but can be deep. The min causes are excessive use of certain drugs and Helicobacter pylori (H.pylori) infection.
A number of drugs cause or aggravate a pre-existing stomach ulcer or result in inflammation of the gastric lining (gastritis). Most of these drugs affect the normal resistance of the gastric lining to acid by disturbing mucus production (the mucus protects the stomach cells), increase gastric acid production or pH or affect the clotting process which will assist with ‘sealing’ any bleeds. Some of the drugs that commonly cause or aggravate stomach bleeding includes :
- NSAIDs, like ibuprofen and aspirin.
- Anticoagulants, like heparin, warfarin.
- Selective-serotonin reputake inihibitors (SSRI’s used for depression and mood disorders)
A number of lifestyle factors may aggravate stomach ulcers. This includes :
- Cigarette smoking
Gastritis is the inflammation and/or erosion of the stomach lining. There may not be any ulceration (open sores) but the persistent inflammation can lead to bleeding. Many of the causes and aggravating factors of stomach ulcers will contribute to gastritis. Apart from an H.pylori infection which is the most common infectious cause, viral and fungal infections may also contribute to the development of gastritis.
A Mallory Weiss tear is the second most common cause stomach bleeding. The tear occurs at the gastroesophageal junction (where the esophagus meets the stomach) and is a result of excessive pressure or force on the stomach as a result of :
- Chronic coughing
These causes are usually persistent and extremely forceful in order for the tear to occur.
Gastris bleeding due to stomach cancer is a common occurrence. Depending on the size of the tumor, this may vary from occult bleeding to excessive vomiting of bright red blood with no signs of other gastric contents. Other less common tumors like an angioma may also account for stomach bleeding.
Rare Causes of Stomach Bleeding
- Congenital Arteriovascular Malformation
Congenital abnormalities of the artery-vein conduit for blood flow may account for stomach bleeding especially in infants and children. This may be associated with Osler-Weber-Rendu syndrome. There are other types of arteriovascular malformations (AVM), some of which is mentioned below, and may not be present from birth.
- Portal Hypertensive Gastropathy
Increased blood pressure within the portal vein that drains blood from the stomach towards the liver may result in the formation of varices (distended vein) which is prone to bleeding.
- Dieulafoy Lesion
Distension or bulging of the arteries which can lead to bleeding in the stomach cavity.
Post-operative bleeding is always a possibility shortly after surgery. It may be a long term risk in cases of gastric bypass surgery for medical weight loss.