Bleeding in the



Digestive Tract

 National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

Bleeding in the digestive tract is a symptom 

of a disease rather than a disease itself. A 

number of different conditions can cause 

bleeding. Most causes of bleeding are 

related to conditions that can be cured 

or controlled, such as ulcers or hemorrhoids. Some causes of bleeding may be 

life threatening. 

Locating the source of bleeding is important. 

Different conditions cause bleeding in the 

upper digestive tract and the lower digestive 

tract. The upper digestive tract includes the 

esophagus, stomach, and upper portion of 

the small intestine, also called the duodenum. The lower digestive tract includes the 

lower portion of the small intestine; large 

intestine, which includes the colon and 

rectum; and anus. 

What are the signs of 

bleeding in the digestive 

tract? 

The signs of bleeding in the digestive tract 

depend on the site and severity of bleeding. 

Signs of bleeding in the upper digestive tract 

include 

•	 bright red blood in vomit 

•	 vomit that looks like coffee grounds 

•	 black or tarry stool 

The digestive tract 

Esophagus 

Stomach 

Duodenum 

Rectum Anus 

Small 

intestine 

Colon 

(shaded) 

•	 dark blood mixed with stool 

•	 stool mixed or coated with bright red 

blood 

Signs of bleeding in the lower digestive tract 

include 

•	 black or tarry stool 

•	 dark blood mixed with stool 

•	 stool mixed or coated with bright red 

blood 
 

 

Sudden, severe bleeding is called acute 

bleeding. If acute bleeding occurs, symptoms 

may include 

•	 weakness 

•	 dizziness or faintness 

•	 shortness of breath 

•	 crampy abdominal pain 

•	 diarrhea 

•	 paleness 

A person with acute bleeding may go into 

shock, experiencing a rapid pulse, a drop 

in blood pressure, and difficulty producing 

urine. 

Light bleeding that continues for a long time 

or starts and stops is called chronic bleeding. 

If bleeding is chronic, a person may notice 

that fatigue, lethargy, and shortness of breath 

develop over time. Chronic blood loss can 

also lead to anemia, a condition in which the 

blood’s iron-rich substance, hemoglobin, is 

diminished. 

A person may not notice a small amount of 

bleeding in the digestive tract. This type of 

bleeding is called occult bleeding. Simple 

tests can detect occult blood in the stool. 

What causes bleeding in the 

digestive tract? 

A variety of conditions can cause bleeding in 

the digestive tract. Causes of bleeding in the 

upper digestive tract include the following: 

•	 Peptic ulcers. Helicobacter pylori 

(H. pylori) infections and long-term use 

of nonsteroidal anti-inflammatory drugs 

(NSAIDs), such as aspirin and ibuprofen, are common causes of peptic ulcers. 

•	 Esophageal varices. Varices, or 

enlarged veins, located at the lower end 

of the esophagus may rupture and bleed 

massively. Cirrhosis is the most common cause of esophageal varices. 

•	 Mallory-Weiss tears. These tears in the 

lining of the esophagus usually result 

from vomiting. Increased pressure in 

the abdomen from coughing, hiatal hernia, or childbirth can also cause tears. 

•	 Gastritis. NSAIDs and other 

drugs, infections, Crohn’s disease, 

illnesses, and injuries can cause 

gastritis—inflammation and ulcers in 

the lining of the stomach. 

•	 Esophagitis. Gastroesophageal reflux 

disease (GERD) is the most common 

cause of esophagitis—inflammation and 

ulcers in the lining of the esophagus. In 

GERD, the muscle between the esophagus and stomach fails to close properly, 

allowing food and stomach juices to 

flow back into the esophagus. 

•	 Benign tumors and cancer. A benign 

tumor is an abnormal tissue growth that 

is not cancerous. Benign tumors and 

cancer in the esophagus, stomach, or 

duodenum may cause bleeding. 

2	 Bleeding in the Digestive Tract 
 

Causes of bleeding in the lower digestive 

tract include the following: 

•	 Diverticular disease. This disease is 

caused by diverticula—pouches in the 

colon wall. 

•	 Colitis. Infections, diseases such as 

Crohn’s disease, lack of blood flow 

to the colon, and radiation can cause 

colitis—inflammation of the colon. 

•	 Hemorrhoids or fissures. Hemorrhoids 

are enlarged veins in the anus or rectum 

that can rupture and bleed. Fissures, or 

ulcers, are cuts or tears in the anal area. 

•	 Angiodysplasia. Aging causes 

angiodysplasia—abnormalities in the 

blood vessels of the intestine. 

•	 Polyps or cancer. Benign growths or 

polyps in the colon are common and 

may lead to cancer. Colorectal cancer 

is the third most common cancer in the 

United States and often causes occult 

bleeding.1 

1Common cancer types. National Cancer 


Institute website. www.cancer.gov/cancertopics/
 

commoncancers#1. Updated May 7, 2009. Accessed 


October 26, 2009.
 

How is bleeding in the 

digestive tract diagnosed? 

The first step in diagnosing bleeding in the 

digestive tract is locating the site of the 

bleeding. The doctor will take the patient’s 

complete medical history and perform a 

physical examination. Symptoms such as 

changes in bowel habits, black or red stools, 

and pain or tenderness in the abdomen may 

tell the doctor which area of the digestive 

tract is bleeding. 

The doctor may need to test the stool for 

blood. Iron supplements, bismuth subsalicylate (Pepto-Bismol), or certain foods such as 

beets can give the stool the same appearance 

as bleeding from the digestive tract. Stool 

tests can also show bleeding that is not visible 

to the patient. 

A blood test can help determine the extent 

of the bleeding and whether the patient is 

anemic. 

Nasogastric lavage is a procedure that can 

be used to determine whether the bleeding 

is in the upper or lower digestive tract. With 

nasogastric lavage, a tube is inserted through 

the nose and into the stomach. The contents of the stomach are removed through 

the tube. If the stomach contains bile and 

does not contain blood, the bleeding either 

has stopped or is likely in the lower digestive 

tract. 

3	 Bleeding in the Digestive Tract 
 

Endoscopy	


Endoscopy is the most common method for 

finding the source of bleeding in the digestive 

tract. An endoscope is a flexible tube with a 

small camera on the end. The doctor inserts 

the endoscope through the patient’s mouth 

to view the esophagus, stomach, and duodenum. This examination is called esophagogastroduodenoscopy (EGD). An endoscope 

can also be inserted through the rectum to 

view the colon. This procedure is called 

colonoscopy. The doctor can use the endoscope to do a biopsy, which involves collecting small samples of tissue for examination 

with a microscope. 

Bleeding that cannot be found with endoscopy is called obscure bleeding. The doctor may repeat the endoscopy or use other 

procedures to find the cause of obscure 

bleeding. 

Enteroscopy 

Enteroscopy is an examination of the small 

intestine. Because traditional endoscopes 

cannot reach the small intestine, special 

endoscopes are used for enteroscopy. 

Enteroscopy procedures include 

•	 Push enteroscopy. A long endoscope 

is used to examine the upper portion of 

the small intestine. 

•	 Double-balloon enteroscopy. Balloons 

are mounted on the endoscope to help 

the endoscope move through the entire 

small intestine. 

•	 Capsule endoscopy. The person swallows a capsule containing a tiny camera. 

The camera transmits images to a video 

monitor as the capsule passes through 

the digestive tract. This procedure is 

designed to examine the small intestine, 

but it also allows the doctor to examine 

the rest of the digestive tract. 

Other Procedures 

Several other methods can help locate the 

source of bleeding: 

•	 Barium x rays. Barium is a contrast 

material that makes the digestive tract 

visible in an x ray. A liquid containing 

barium is either swallowed or inserted 

into the rectum. Barium x rays are less 

accurate than endoscopy and may interfere with other diagnostic techniques. 

•	 Radionuclide scanning. The doctor 

injects small amounts of radioactive 

material into the person’s vein. A special camera, similar to an x-ray machine, 

can detect this radiation and create 

images of blood flow in the digestive 

tract. Radionuclide scanning is sensitive 

enough to detect very slow bleeding, but 

it is not as accurate as other procedures. 

•	 Angiography. A dye is injected into 

the person’s vein to make blood vessels visible in x-ray or computerized 

tomography (CT) scans. Dye leaks 

out of the blood vessels at the bleeding 

site. In some cases, the doctor can use 

angiography to inject medicine or other 

material into blood vessels to try to stop 

the bleeding. 

•	 Exploratory laparotomy. If other 

methods cannot locate the source of the 

bleeding, a surgical procedure may be 

necessary to examine the digestive tract. 

4 Bleeding in the Digestive Tract 
 

How is bleeding in the 

digestive tract treated? 

Endoscopy can be used to stop bleeding in 

the digestive tract. A doctor can insert tools 

through the endoscope to 

•	 inject chemicals into the bleeding site 

•	 treat the bleeding site and surrounding 

tissue with a heat probe, electric current, or laser 

•	 close affected blood vessels with a band 

or clip 

Endoscopy does not always control bleeding. 

Angiography can be used to inject medicine or other material into blood vessels to 

control some types of bleeding. If endoscopy 

and angiography do not work, the patient 

may need other treatments or surgery to stop 

the bleeding. 

To prevent bleeding in the future, doctors 

can treat the conditions that cause bleeding, 

such as 

•	 H. pylori and other infections 

•	 GERD 

•	 ulcers 

•	 hemorrhoids 

•	 polyps 

•	 inflammatory bowel diseases 

Points to Remember 

•	 Bleeding in the digestive tract is a 

symptom of a disease rather than a 

disease itself. 

•	 A number of different conditions 

can cause bleeding in the digestive 

tract. 

•	 Finding the location and cause of 

the bleeding is important. 

•	 Most causes of bleeding can be 


cured or controlled.
 

•	 Endoscopy is the most common tool 

for diagnosing and treating bleeding 

in the digestive tract. 

Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

sponsors research to improve treatment for 

patients with digestive diseases that cause 

bleeding in the digestive tract, including 

diverticular disease, GERD, and inflammatory bowel diseases. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov. 

5	 Bleeding in the Digestive Tract 
 

 

 

 

 

 

 

 

 

 

 

For More Information 

American College of Gastroenterology 

P.O. Box 342260 

Bethesda, MD 20827–2260 

Phone: 301–263–9000 

Internet: www.acg.gi.org 

American Gastroenterological Association 

National Office 

4930 Del Ray Avenue 

Bethesda, MD 20814 

Phone: 301–654–2055 

Fax: 301–654–5920 

Email: member@gastro.org 

Internet: www.gastro.org 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK 

scientists and outside experts. This publication was reviewed by David A. Peura, M.D., 

University of Virginia Health System. 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov. 

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) 

or visit www.fda.gov. Consult your doctor for more 

information. 

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory. 

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Information Clearinghouse 

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Phone: 1–800–891–5389 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The 

NIDDK is part of the National Institutes of 

Health of the U.S. Department of Health 

and Human Services. Established in 1980, 

the Clearinghouse provides information 

about digestive diseases to people with 

digestive disorders and to their families, 

health care professionals, and the public. 

The NDDIC answers inquiries, develops and 

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and Government agencies to coordinate 

resources about digestive diseases. 

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. 

This publication is available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 10–1133 

January 2010