Bleeding Stomach – Symptoms and Causes of Gastric Bleeding

Gastric bleeding refers to bleeding in the stomach. The lining of the stomach wall has an extensive network of blood vessels. Consequently, gastric bleeding can occur easily due to injury (cuts, tears, and sores), inflammation or infection of the stomach wall. Gastric bleeding is also referred to as gastric hemorrhage or gastrorrhagia.
Gastrointestinal bleeding is a serious condition.

Immediate medical attention must be sought in such cases. Signs and symptoms that accompany bleeding in the gastrointestinal tract are not sufficient to identify the exact site of bleeding. Additional investigations are usually done to identify the exact site and cause of bleeding. Blood in the stomach can also come from bleeding that occurs in other parts of the gastrointestinal tract, such as the esophagus or the duodenum.

However, most cases are a result of bleeding within the stomach itself. A variety of conditions can cause acute or chronic bleeding in the stomach. Some of the conditions may resolve on their own. However, others may be serious and require medical treatment.

Signs and Symptoms

Gastric bleeding can cause the following signs and symptoms:

  • Blood in the stool: Blood may appear in the stool either as fresh blood or as old blood. Presence of fresh blood in the stool is referred to as hematochezia. Old blood in the stool may cause the stool to appear as a black tarry mass (technically referred to as melena).
  • Vomiting up blood: Fresh blood may come out in the vomit (technically referred to as hematemesis). Old blood may also come out in the vomit as brown or black spots that resemble ground coffee.
  • Abdominal pain: Pain may occur in the epigastric region of the abdomen. The nature of the abdominal pain may range from sharp, stabbing pain to cramps.
  • Other symptoms:
    – Fatigue, shortness of breath, lightheadedness or dizziness may occur when gastric bleeding is copious.
    – Anemia, pallor, low blood pressure, high heart rate and shock may also occur when blood loss is significant.
    – Indigestion and heartburn may occur.
    – Lack of appetite may lead to loss of weight in some cases.
    – Patients may sometimes report a smell or taste of blood.

It is important to note that all of the above mentioned signs and symptoms may not always be present. Also, it is important to distinguish between gastric (stomach) bleeding and bleeding from other parts of the gastrointestinal tract. This cannot be done on the basis of the signs and symptoms alone. Diagnostic investigations like an endoscopy are usually done to confirm the site of the bleeding.

Read more on bleeding in the bowels.

Causes of Gastric Bleeding

Stomach ulcers: Ulcers in the stomach are a common occurrence. Bleeding from open gastric ulcers is the most common cause of bleeding in the stomach. Bleeding from stomach ulcers can occur intermittently over a long period of time (several weeks to months). Alternatively, significant bleeding from stomach ulcers can occur suddenly. This is a dangerous situation that can even be lethal (especially in elderly patients) without treatment.

The main causes of gastric ulcers are infection with the bacteria Helicobacter pylori, excessive use of certain drugs (such as non-steroidal anti-inflammatory drugs or NSAIDs), and certain lifestyle factors. Helicobacter pylori (also referred to as H. pylori) infection is one of the most common causes of stomach ulcers. This bacteria affects the mucus coat on the inner lining of the stomach wall.

Along with the highly acidic gastric acid, H. pylori infection can damage the lining of the stomach wall, causing bleeding ulcers. A variety of drugs can either cause or aggravate gastric bleeding. Drugs can affect mucus production, thereby decreasing the normal resistance of the gastric mucosa to the effects of the strong stomach acid. Many drugs also cause increased gastric acid production and affect the clotting process.

Examples of some common drugs that can cause or aggravate gastric bleeding include non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors. Apart from infections and drugs, certain lifestyle factors, such as stress, excessive alcohol consumption, and cigarette smoking can lead to gastric bleeding by aggravating stomach ulcers.

  • Gastritis: Gastritis refers to an inflammation of the inner lining of the stomach. Persistent inflammation of the stomach lining can lead to bleeding even in the absence of ulcers. Many factors that contribute to the formation and aggravation of stomach ulcers also lead to gastritis. For example, H. pylori infection, medication with non-steroidal anti-inflammatory drugs, and excessive consumption of alcohol can all lead to gastritis. In addition, viral and fungal infections can also cause gastritis. This is especially the case in immunocompromised patients (such as patients with HIV infection). Gastritis can also be caused by diseases such as Hashimoto’s thyroiditis and other autoimmune disorders.
  • Mallory-Weiss tear: Mallory-Weiss tear refers to a tear at the gastroesophageal junction where the stomach and the esophagus meet. The Mallory-Weiss tear is usually caused by conditions that put excessive force or pressure on the stomach. Examples of such conditions include forceful vomiting, retching, convulsions and chronic cough. The tear occurs when these conditions are chronic. Mallory-Weiss tear is the second most common cause of gastric bleeding.
  • Stomach cancer: Gastric bleeding can also be caused by stomach cancers. Gastric stromal tumor is one of the more common gastric tumors that can cause bleeding in the stomach. The amount of bleeding depends on the size of the gastric stromal tumor. Small tumors may cause occult or hidden bleeding. In other cases, copious amounts of bright red blood may be expelled through vomit. Less common tumors like angioma may also cause gastric bleeding.
  • Congenital arteriovascular (AV) malformations: Certain congenital malformations of blood vessels can also cause gastric bleeding. These congenital malformations usually comprise of abnormal artery-vein conduits, and are a potential cause of gastric bleeding in infants and children. An example is the Osler-Weber-Rendu syndrome. Some types of arteriovascular malformations may not be present since birth.
  • Portal hypertensive gastropathy: The portal vein carries blood from the stomach to the liver. Increased pressure within the portal vein can lead to its distension. Such distended veins are susceptible to getting ruptured. Some cases of gastric bleeding may be attributed to portal hypertensive gastropathy.
  • Dieulafoy’s lesion: Dieulafoy’s lesion refers to a rare condition that is characterized by the presence of a large distended arteriole in the stomach wall. This distended arteriole can bleed into the gastric cavity. Dieulafoy’s lesion is a potentially lethal condition.
  • Surgery: Gastric bleeding can also be caused by certain surgical procedures. For example, individuals who undergo gastric bypass surgery have a long term risk of developing gastric bleeding.

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