Don't Ignore Your Symptoms of Gastrointestinal Bleeding

Arthritis patients take several medications that increase the risk of gastrointestinal bleeding. If you have taken one of these medications for a long time, you may be lulled into a false sense of security that all is well. It's critical that you know the signs of gastrointestinal bleeding—because it can happen at any time and it can quickly become an emergency.

What Is Gastrointestinal Bleeding?

Gastrointestinal bleeding refers to any bleeding that occurs in the gastrointestinal tract, which runs from your mouth to your anus. More specifically, the gastrointestinal tract is divided into the upper gastrointestinal tract and the lower gastrointestinal tract. The upper gastrointestinal tract is the section between the mouth and the outflow tract of the stomach. The lower gastrointestinal tract is the section from the outflow tract of the stomach to the anus, including the small and large bowel.

Gastrointestinal bleeding ranges from microscopic amounts of blood to massive bleeding. The amount of bleeding and the location of bleeding determine what needs to be done to stop the bleeding. There are numerous conditions that can cause gastrointestinal bleeding. Because it is a known potential serious side effect of certain medications taken for arthritis—NSAIDs (nonsteroidal anti-inflammatory drugs) and corticosteroids—patients taking those drugs must not ignore any sign of bleeding.

GI bleeding also can be associated with aspirin use as well as blood thinners.

Symptoms Associated With Gastrointestinal Bleeding

First of all, it's important to realize that since gastrointestinal bleeding is internal, there is not always pain to serve as an indicator of the severity of the problem.

Symptoms of upper gastrointestinal bleeding include:

• Vomiting bright red blood (hematemesis)
• Vomiting dark clots, or coffee ground-like material
• Passing black, tar-like stool (melena)

Symptoms of lower gastrointestinal bleeding include:

• Passing pure blood (hematochezia) or blood mixed in stool
• Bright red or maroon blood in the stool

Hematemesis is present in 50% of upper gastrointestinal bleeding cases. Hematochezia is seen in 80% of all gastrointestinal bleeding. Melena is present in 70% of upper gastrointestinal bleeding and 33% of lower gastrointestinal bleeding. To form black, tarry stools (melena), there must be 150-200 cc of blood and the blood must be in the gastrointestinal tract for 8 hours to turn black. So, by the time you see black stools, there already has been significant bleeding.

Why Is It Important to Not Ignore Signs of Bleeding?

A person who is bleeding from their gastrointestinal tract may begin to show signs of shock or hypovolemia (decrease in the volume of circulating blood). Other indicators of an emergency situation related to the gastrointestinal bleeding would be:

• Tachycardia (rapid heartbeat)
• Tachypnea (rapid respiration)
• Hypotension (low blood pressure)
• Syncope (faint)
• Pallor (paleness)
• Diaphoresis (sweating)
• Oliguria (decreased urine production)
• Confusion

Remember, if you have these signs or symptoms you should seek emergency medical care immediately. If the bleeding is significant, it is important to receive intravenous fluids, airway management, and blood transfusions to be stabilized—even during the initial evaluation to determine the specific source of the bleeding.

Points to Remember

It is estimated that more than 100,000 Americans are hospitalized and between 15,000 and 20,000 die each year from ulcers and gastrointestinal bleeding related to NSAID use. Speaking only of arthritis, 14 million patients take NSAIDs regularly—up to 60% of whom will experience gastrointestinal side effects as a result.

Because there is a known risk of ulcers and gastrointestinal bleeding with NSAIDs and corticosteroids, people who take those drugs must be extra vigilant. Their family members who live with them must also be taught about the warning signs of gastrointestinal bleeding. While it's never fun to go to an emergency room or be in the hospital, gastrointestinal bleeding can be serious. Do the right thing—don't ignore your symptoms. Your life may depend on it.

Read more about the effects of medicine on the stomach.