Conditions that can lead to upper gastrointestinal bleeding (90% of gastrointestinal bleeds):
Cardiovascular (I00-I99).
- Aorto-intestinal fistula (AEF)-connection between the aorta and the gastrointestinal tract-rare but life-threatening complication in the spontaneous course of an aortic aneurysm (primary form) or else as a postoperative event after prosthetic replacement of the aorto-iliac vascular segment (secondary fistula)
- Vascular lesions (vascular injuries), unspecified.
- Osler-Weber-Rendu disease (synonyms: Osler disease; Osler syndrome; Osler-Weber-Rendu disease; Osler-Rendu-Weber disease; hereditary hemorrhagic telangiectasia, HHT) – autosomal-dominant inherited disorder in which telangiectasias (abnormal dilation of blood vessels) occur. These can occur anywhere, but are found especially in the nose (leading symptom: epistaxis (nosebleed)), mouth, face, and the mucous membranes of the gastrointestinal tract. Because the telangiectasias are very vulnerable, it is easy to tear and thus bleeding.
Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).
- Hemobilia – hemorrhage within the bile ducts, mostly with leakage of blood from the papilla duodeni major (papilla Vateri).
- Cirrhosis – irreversible (non-reversible) damage to the liver and a pronounced remodeling of liver tissue.
Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).
- Angiodysplasias (synonym: vascular dysplasia) – vascular malformations of the stomach/duodenum (duodenum) such as the so-called watermelon stomach.
- Dieulafoy lesion (synonym: exulceratio simplex) – rare form of bleeding ventriculi ulcer (gastric ulcer), which can develop in a congenital (congenital) anomaly of blood vessels of the stomach wall
- Erosive duodenitis (duodenitis).
- Erosive gastritis (gastritis).
- Fundic varices – dilatation of the veins of the fundus (localization in the stomach).
- Gastrointestinal erosions – loss of substance of the mucous membrane of the gastrointestinal tract.
- Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
- Gastric prolapse (gastric prolapse)
- Mallory-Weiss syndrome – clustered longitudinal (elongated) tears of the mucosa (mucous membrane) and submucosa (submucosal connective tissue) of the esophagus occurring in alcoholics, which may be associated with potentially life-threatening bleeding of the external esophagus and/or gastric inlet (gastrointestinal bleeding/GIB) as a complication.
- Esophageal varices – dilatation of the veins of the esophagus caused by high blood pressure in the hepatic circulation.
- Ulcus duodeni (duodenal ulcer).
- Ulcus ventriculi (gastric ulcer)
Musculoskeletal system and connective tissue (M00-M99)
- Vasculitides – inflammatory rheumatic diseases characterized by a tendency to inflammation of the (usually) arterial blood vessels (aggressive immunosuppressive therapy required).
Neoplasms – tumor diseases (C00-D48).
- Gastric carcinoma (stomach cancer)
- Esophageal carcinoma (cancer of the esophagus)
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).
- Hemoptysis (hemoptysis).
Injuries, poisoning, and other sequelae of external causes (S00-T98).
- Iatrogenic – damage caused by medical intervention.
- Foreign body
- Injuries, unspecified
Medication
- Antithrombotic agents (heparin group, factor Xa inhibitors/direct thrombin inhibitors) (approximately 5.9%).
- Nonsteroidal anti-inflammatory drugs (NSAIDs)-risk increase (OR 3.75); long-term use results in gastroduodenal ulcers (gastric and duodenal ulcers)Note: Use of selective cyclooxygenase-2 inhibitors has a lower gastrointestinal bleeding risk compared with traditional NSAIDs (tNSARs).
- Selective serotonin reuptake inhibitors (SSRIs): including fluoxetine, paroxetine, citalopram, sertraline – 55% increase in risk (OR 1.55, 95% CI 1.35-1.78, p < 0.001)
- Combination of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal anti-inflammatory drugs (NSAIDs) (OR 6.33, 95% CI: 3.40-11.8; P < 0.00001)
- Antiplatelet agents (TAH; acetylsalicylic acid (ASA]), clopidogrel, prasugrel, ticagrelor) – risk increase (OR 2.48).
- Joint use of all three drug groups mentioned above: Risk of upper GI bleeding approximately 9-fold (OR 9.13, 95% CI 1.12-74.77).
- See also under “Bleeding due to medications”
Conditions that can lead to lower gastrointestinal bleeding (10% of gastrointestinal bleeding cases)
Cardiovascular (I00-I99).
- Hemorrhoids (approximately 80% of cases).
- Lymph node hyperplasia, unspecified.
Infectious and parasitic diseases (A00-B99).
Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).
- Acute mesenteric ischemia (AMI; intestinal infarction, mesenteric artery occlusion, mesenteric infarction, mesenteric occlusive disease, angina abdominalis).
- Anal fissure – tear in the mucosa of the anus.
- Angiodysplasias (vascular malformations) of the stomach/duodenum (duodenum).
- Colitis (inflammation of the intestine), ischemic or radiation-induced.
- Ulcerative colitis – inflammatory bowel disease (IBD).
- Diverticulitis – disease of the colon in which inflammation forms in protrusions of the mucosa (diverticula).
- Diverticular bleeding
- Small intestinal varices – dilatation of veins in the small intestine.
- Invagination – invagination of a portion of the intestine into the aborally following intestinal segment.
- Meckel’s diverticulum – protrusion of the ileum (scimitar or hip bowel; part of the small intestine) that represents a remnant of the embryonic yolk duct (omphaloenteric duct)
- Crohn’s disease – chronic inflammatory bowel disease (IBD); usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal segments may be affected, which are separated by healthy sections.
- Proctitis (rectal inflammation).
- Rectal ulcers – ulcers in the rectum.
- Radiation proctitis (inflammation of the rectum after radiotherapy, for example, in prostate cancer).
Neoplasms – tumor diseases (C00-D48).
- Colorectal tumors, unspecified.
- Tumors of the small intestine, unspecified
- Mastocytosis – two main forms: cutaneous mastocytosis (skin mastocytosis) and systemic mastocytosis (whole body mastocytosis); clinical picture of cutaneous mastocytosis: Yellowish-brown spots of varying size (urticaria pigmentosa); in systemic mastocytosis, there are also episodic gastrointestinal complaints (gastrointestinal complaints), (nausea (nausea), burning abdominal pain and diarrhea (diarrhea)), ulcer disease, and gastrointestinal bleeding (gastrointestinal bleeding) and malabsorption (disorder of food absorption); In systemic mastocytosis, there is an accumulation of mast cells (cell type that is involved in, among other things, allergic reactions). Among other things, involved in allergic reactions) in the bone marrow, where they are formed, as well as accumulation in the skin, bones, liver, spleen and gastrointestinal tract (GIT; gastrointestinal tract); mastocytosis is not curable; course usually benign (benign) and life expectancy normal; extremely rare degeneration mast cells (= mast cell leukemia (blood cancer)).
- Polyp bleeding
Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99)
- Endometriosis – Occurrence of endometrium (lining of the uterus) outside the uterus, such as in or on the ovaries (ovaries), tubes (fallopian tubes), urinary bladder, or bowel.
Injuries, poisoning, and other sequelae of external causes (S00-T98).
- Iatrogenic – damage caused by medical intervention.
- Foreign body
- Injuries, unspecified
Medication
- Taking iron, charcoal, or bismuth supplements may cause stool discoloration
- Drug side effects: “bleeding from medications”; often non-steroidal anti-inflammatory drugs (NSAIDs) (e.g.B. ASA therapy at age > 75 y. high risk; 50% of cases source of bleeding is in upper gastrointestinal tract); antithrombotic agents (heparin group, Factor Xa inhibitors/direct thrombin inhibitors).
- Simultaneous use of anticoagulants (anticoagulants; vitamin K antagonists such as Marcumar, factor Xa inhibitors such as rivaroxaban, apixaban or edoxaban or factor II inhibitors such as dabigatran) and antibiotics leads to an increased risk of bleeding!
- The combination of acetylsalicylic acid (ASA) and clopidogrel leads to severe gastrointestinal bleeding with similar frequency as vitamin K antagonists.
- Dual antiplatelet therapy and anticoagulation result in a similar gastrointestinal bleeding risk.
- For direct oral anticoagulants (DOAKs), annual bleeding rates ranging from 0.4-3.2% were reported in pivotal trials.
- Corticosteroids
- Selective serotonin reuptake inhibitors: fluoxetine, paroxetine, citalopram, sertraline, among others.
Operations
- Condition after colonoscopy with polypectomy (colonoscopy with polyp removal).
- Condition after hemorrhoidal sclerotherapy (hemorrhoid sclerotherapy) or ligation (by rubber band ligation).
- Condition after prostate punch (tissue removal from the prostate to clarify abnormal findings).
Further
- Consumption of blueberries, licorice or beet may cause stool discoloration
Other tips
- The risk of gastrointestinal bleeding is not higher with NOAKs (rivaroxaban, dabigatran) than with vitamin K antagonists (VKA) in population-based studies.
- It should be noted that with increasing age, the risk of GI bleeding increases more with NOAKS than with warfarin.