Gastrointestinal Bleeding & Variceal Treatment

Urgent care

Recognising gastrointestinal bleeding

Gastrointestinal bleeding is blood loss from anywhere in the digestive tract. It ranges from a minor, self-limiting bleed to a life-threatening emergency, and the difference is often not obvious to the patient. Recognising which is which, and acting quickly, is what matters most.

• Haematemesis — vomiting fresh red blood, or dark material resembling coffee grounds.
• Melaena — black, tarry, offensive-smelling stools, indicating bleeding higher up in the gut.
• Haematochezia — fresh red blood in or on the stool, which usually indicates bleeding from the lower gut.
• Occult bleeding — no visible blood at all, discovered only as iron-deficiency anaemia on a blood test.

Blood that has been in the gut for some hours appears black; blood passed quickly appears red. This is why the colour of the blood helps locate the source, but does not by itself tell you how serious the bleed is.

Common causes

• Peptic ulcer
• Gastritis and duodenitis
• Mallory-Weiss tear
• Oesophageal varices
• Gastric varices
• Portal hypertensive gastropathy
• Oesophagitis and reflux erosions
• Angiodysplasia
• Colonic polyps and colorectal cancer
• Diverticular bleeding
• Haemorrhoids and anal fissure
• Inflammatory bowel disease

How bleeding is managed endoscopically

After initial stabilisation, an upper GI endoscopy (or colonoscopy, depending on the likely source) identifies the site and usually allows treatment in the same session. Techniques used include:

• Injection therapy — adrenaline injection to reduce bleeding and clear the field.
• Thermal therapy — heater probe or bipolar coagulation to seal the bleeding vessel.
• Mechanical therapy — through-the-scope clips, which physically close the bleeding point.
• Band ligation — the standard treatment for oesophageal varices, where small rubber bands are applied to the varix.
• Glue (cyanoacrylate) injection — for gastric varices, which do not respond well to banding.
• Argon plasma coagulation — for superficial vascular lesions.

The choice depends on the type and site of the bleed. More than one technique is sometimes used in the same procedure. Where bleeding cannot be controlled endoscopically, or where it recurs despite treatment, interventional radiology or surgical options may be required, and we would coordinate that referral.

Varices, cirrhosis and prevention

In cirrhosis, pressure in the portal vein rises and can produce enlarged veins — varices — in the food pipe and stomach. These can bleed suddenly and heavily. The crucial point is that this risk can be anticipated: patients with cirrhosis are screened by endoscopy, and varices found at higher risk of bleeding are treated before a bleed occurs, either by band ligation or with medication that lowers portal pressure. If you have cirrhosis and have not had a screening endoscopy, please arrange one.

After a variceal bleed has been treated, a planned programme of repeat band ligation sessions is usually needed until the varices are eradicated, followed by ongoing surveillance. More detail is on the liver disease and cirrhosis page.

Lower GI bleeding

Bleeding from the colon is often caused by haemorrhoids or diverticular disease, but in an older patient or in someone with anaemia or a change in bowel habit it must be taken seriously. Colonoscopy is used both to locate the source and to treat it. More detail is on the colonoscopy page.