Internal Medicine

Gastric bleeding

synonym

gastrointestinal bleeding

definition

Under one Gastric bleeding one understands a bleeding source caused by different underlying diseases in the area of the Stomach with corresponding symptoms and partially life-threatening Follow that as soon as possible action and Diagnosis makes necessary.

Causes / forms

In over half of the cases, the cause is one Gastric bleeding in one Gastric ulcer (Duodenal ulcer, ventricular ulcer), which has gone unnoticed in the Stomach wall has developed and eventually leads to bleeding.

In about 50% of cases, patients with gastric bleeding have one or more of them Ulcers.
Gastric bleeding occurs somewhat less often (15%) Wandering gastric erosions. In most cases, this form of wall changes comes from the fact that too little Gastric mucosa was built that Stomach acid but comes into unhindered contact with the unprotected stomach wall. This attacks the stomach wall and bleeding may occur. In most cases, decreased mucosal production comes from chronic ingestion anti-inflammatory drugs (NSAID).
In about 1-5% of cases of gastric bleeding the cause is malignant Tumor development in the stomach (Gastric cancer). In rare cases, benign tumors can also cause gastric bleeding.

Furthermore, in the case of severe inflammation of the gastric mucosa (chronic gastritis) bleeding in the stomach. Chronic and intense Alcohol consumption with strong alcohol can cause such chronic gastritis.
Gastric bleeding occurs relatively rarely Vascular malformations in the area of the stomach wall (so-called Angiodysplasia) conditions. These are already applied at birth and do not cause any discomfort.
They are characterized by

strong winding Vascular anatomies with
bulging filled Vessel lumen and accordingly
high blood pressure in the vessels.

Either that Angiodysplasia open by themselves due to the strong pressure or angular, poorly chewed food residues lead to a mechanical injury of the vessel.
In about 5% of the cases one finds never mind gastric bleeding, which in most cases comes to a standstill.

Stomach bleeding from stress

Stress per se does not usually trigger gastric bleeding. However, it is known that Stress increases the incidence of gastric disorders, like for example Stomach ulcer (Ulcera ventriculi or duodeni) and Inflammation of the esophagus can lead. Both diseases increase the risk of bleeding in the stomach area. Stomach ulcers in particular can bleed profusely and cause dangerous blood loss. Symptoms that indicate a stomach ulcer are for example Pressure or pain in the upper abdomen such as Nausea and loss of appetite. Patients who have a stomach ulcer or inflammation of the esophagus are usually medicated with a Acid inhibitors (for example Proton pump inhibitors how Pantozol), this makes the gastric secretion less acidic and the ulcer / inflammation can heal better.

Bleeding in the stomach from alcohol

Alcohol does not directly lead to gastric bleeding either. However, it seems to be proven that With frequent consumption of (high-proof) alcohol, more frequent inflammation of the esophageal mucosa and superficial damage to the gastric mucosa occur. As a result of this mucosal damage, the likelihood for that is Incidence of gastric ulcers increased. Such a gastric ulcer, in turn, can not infrequently bleed; in some cases this can lead to pronounced blood loss with urgent need for clinical treatment.

Bleeding in the stomach from medication

Quite a few drugs are known to do that Significantly increase the risk of ulcers in the stomach area. If there is such an ulcer, there is a risk that it will start to bleed. Sometimes this leads to life-threatening blood loss. In particular, drugs from the group of Non-steroidal anti-inflammatory drugs (NSAIDs), which are taken as pain relievers and anti-inflammatory drugs, significantly increase the risk of developing a stomach ulcer with long-term use. These pain relievers include, among others Ibuprofen and Diclofenac. These drugs are also used with one Cortisone-Preparation combined, like that the risk of developing a stomach ulcer increases by 16 times compared to the normal population.
This is why it is important for patients who need to take regular medication from these groups prophylactic therapy to protect the stomach initiate. Medicines that are also used to treat existing stomach ulcers or inflammation of the mucous membranes are suitable for this (e.g .: Proton pump inhibitors). she reduce acid production in the stomach and therefore inhibit the inflammatory reaction from proceeding. These drugs include, for example Pantozol and Omeprazole. Patients who take regular medication such as ibuprofen should take such an anti-acid tablet once a day. This significantly reduces the risk of gastric ulcer development - and thus the risk of gastric bleeding.
The local application from diclofenac (for example as Voltaren ointment) or ibuprofen does not increase the risk of developing a stomach ulcer.

1. Ibuprofen

Ibuprofen is a drug that pain reliever and anti-inflammatory works and belongs to the group of non-steroidal anti-inflammatory drugs. It is - like other representatives of this group of active ingredients - a popular pain medication. However, if taken regularly, there is one increased risk of developing a stomach ulcer or ulcer of the duodenum. In this respect, if ibuoprofen has to be taken regularly, an additional tablet should be taken to protect the stomach. This is a drug from the group of Acid inhibitors at, for example Pantozol. If taken daily, the risk of developing an ulcer decreases significantly with long-term ibuprofen therapy.

2. Diclofenac

Diclofenac is also a drug from the group of non-steroidal anti-inflammatory drugs and is called Pain relievers and anti-inflammatory drugs used. Like ibuprofen, diclofenac increases the risk of developing an ulcer in the stomach and duodenum when taken regularly. It should therefore With regular use of this pain reliever, comedication with Pantozol, an acid inhibitor This protects the gastric mucosa and counteracts the development of a gastric ulcer in the best possible way.

3. Aspirin

Also aspirin, a popular one Painkiller, which also has anti-inflammatory effects, like ibuprofen and diclofenac, if taken regularly, increases the likelihood of having Development of a stomach ulcer and thus the risk of developing gastric bleeding. In this respect, if aspirin is taken regularly, a stomach protection tablet, for example Pantozol, should be taken daily.

Symptoms

In most cases, the first symptoms of gastric bleeding do not appear until after the bleeding has started.
It also depends on whether the blood is vomited (in the case of massive gastric bleeding) or whether it slowly seeps down through the intestines and is then excreted with the stool. In this case one speaks of the so-called tar stool, because the stool mixed with blood shimmers black, silvery and resembles a tar layer on the street.

If there is massive bleeding from the stomach, the patient is usually vomiting with blood. The mixing of blood and gastric juice leads to an appearance similar to coffee grounds (broken coffee grounds, broken blood). In a few cases gastric bleeding is accompanied by severe pain. Depending on the severity of the blood loss, the blood count shows characteristic signs more or less quickly.

The so-called Hb level in the blood decreases with increasing blood loss. In the case of very severe blood loss, the patient can find himself in a life-threatening situation and even in shock. In this case, the

General condition of the patient worsen very sharply, the
Pulse rise and the
Drop in blood pressure.

In the case of less severe blood loss in the sense of bleeding that lasts for weeks, the patient's general condition would remain stable, but the anemia would quickly lead to chronic fatigue. There would also be a drop in performance.

Also read: Black stools as a symptom of gastric bleeding

Signs

The gastric bleeding itself has no specific signs. Common triggers for gastric bleeding are ulcers in the stomach and duodenum and inflammation of the esophagus. Ulcers are often expressed through Upper abdominal pain and loss of appetite, Inflammation of the esophagus caused Heartburn, burning behind the breastbone and similar complaints. If such complaints occur frequently, it is advisable to consult a doctor. If necessary, the doctor can arrange for a referral to be made to a specialist in digestive tract diseases (gastroenterologist) for further diagnostics. If an ulcer is discovered in good time, appropriate therapy can be initiated and the risk of gastric bleeding can be significantly reduced.

At Vomiting of coffee grounds or vomiting with fresh blood A doctor should be consulted as soon as possible as these are signs of bleeding in the stomach area.

Diagnosis of gastric bleeding

In many cases, gastric bleeding is not diagnosed until hospitalized.
This is because the patient usually cannot interpret symptoms such as tarry stools.

Often either the drop in performance (in the case of oozing gastric bleeding) or in acute cases the vomiting of blood (in the case of heavy bleeding) to the doctor. With the help of a stool test (Haemoccult test), the doctor can see whether there are any tiny blood particles in the patient's stool.

Read more on the topic: Blood in the stool

Furthermore, it should be asked whether there has been a history of gastric bleeding or gastric ulcer. Furthermore, the patient should be asked whether he has been taking anti-inflammatory drugs such as diclofenac or ibuprofen for a long time.

If gastric bleeding is suspected, a blood count must firstly be made to show whether and, if so, how high the blood loss is (Hb drop). Furthermore, a gastroscopy should be performed as soon as possible. The patient is given a short sleep injection and a tube with a camera is pushed through the esophagus into the stomach. The stomach is inspected and the sources of bleeding are shown.

In unclear cases, an MRI according to Sellink can be performed if necessary. Oral contrast agent is administered before the MRI examination, in order to particularly visualize the mucous membrane of the small intestine.

Classification

Both Bleeding in the stomach one subdivides several forms according to Forest be named. At

Forest 1a is it a acute, splashing Bleeding, in
Forest 1b around a acute oozing Bleeding. At
Forest 2a is a Vascular stump visible, at
Forest 2b having a stomach ulcer clotted blood and at
Forest 2c older Blood deposits. At
Forest 3 there is no bleeding, but one or more suspicious ones erosion on the stomach wall.

therapy

A acute and especially splashing Bleeding must be treated promptly to prevent excessive blood loss from the patient and life threatening Prevent situation.

To a splashing Stopping bleeding could be done during the Gastroscopy one Clip place on the squirting vessel to seal it. Furthermore, a substance could be near the source of the bleeding injected be that the vessel pull together and thus can be closed. The gastroscopy is a method with few side effects, serious complications rarely occur.

Both after treatment of acute bleeding and after diagnosis of non-acute bleeding (in this case no further measures would be taken during the gastroscopy), one should Gastric protection medication start to get the corrosive Stomach acid of Stomach to reduce. Furthermore should anti-inflammatory Medication paused to ensure that the protective stomach lining can form again.
Regular Follow-up checks of the stool and repetitions of gastroscopy should be performed.

Summary

The most common causes of Bleeding in the stomach are Stomach ulcerswhich initially went unnoticed over the years Gastric mucosa dig in and eventually cause bleeding.
Are less common malignant tumors and Vascular malformations.
Erosions the stomach wall, which by long Drug use the group NSAID can also lead to gastric bleeding.

Symptoms bleeding in your stomach

Drop in performance and
fatigue (with slow oozing bleeding) and so-called
Tarry stool (for chronic oozing bleeding) or
Vomiting blood (Breaking coffee grounds) in acute spurting bleeding.

A striking one Blood count With Hb drop also indicates a loss of blood, possibly due to bleeding in the stomach down.
As Diagnosis you would next to that

Blood count and the
Stool diagnostics (Hemoccult) also one
Gastroscopy carry out.

During the examination, bleeding can be targeted by means of an introduced Clips being stopped. Furthermore, at the source of bleeding too Injected medication which cause the vessels to contract. After a diagnosis of gastric bleeding should anti-inflammatory Medication paused and with a acid inhibiting Treatment (e.g. Proton pump inhibitors) can be started.