What Is the Main Idea?

Acute and chronic gastrointestinal bleeding are common symptoms of a whole range of diseases of the digestive tract. The acute form can be considered an emergency condition, and current medical advice is to seek medical care if you have any of its symptoms. This post goes into the types, symptoms, and approaches to diagnose and treat gastrointestinal bleeding.

What Else Can You Learn?

The open access case report “Endoscopic Hemostatic Treatment for Acute Gastrointestinal Bleeding by Combined Modality Therapy with PuraStat and Endoscopic Hemoclips”, published in the journal Case Reports in Gastroenterology, focuses on a method for stopping the bleeding that combines a special hydrogel and endoscopic hemoclips. This post has a short summary of the case report as an example of the ways gastrointestinal bleeding can be treated.

What Is Gastrointestinal Bleeding?

Any bleeding that starts within the gastrointestinal tract (also called the digestive tract) is called gastrointestinal bleeding. It can be acute (short-term) or chronic (long-term) and overt (visible to the patient because it comes out in vomit or stool) or occult (internal with no visible component). It can be in the upper tract (mouth, throat, esophagus, stomach) or lower tract (small and large intestines, including the anus).

Generally, chronic gastrointestinal bleeding involves small amounts over a long time and may be caused by a whole range of diseases, including hemorrhoids and anal fissures, ulcers, reflux esophagitis, Crohn’s disease and other conditions that cause gastritis, polyps in the colon, ulcers in the stomach (peptic ulcers) or intestine (colitis), minor injuries, or gastrointestinal tract cancer. Chronic bleeding can lead to anemia.

Acute gastrointestinal bleeding can be considered an emergency condition. It is common and often requires hospitalization to deal with it. If it is severe, it can be rapidly debilitating. All the causes of chronic bleeding can also cause acute bleeding. Major injuries can also be the cause.

Technically, acute gastrointestinal bleeding can also describe situations with a small amount of blood from a source that quickly heals and doesn’t bleed again. However, people probably wouldn’t even notice this happening unless the bleeding was from the mouth or anus (e.g., spotting from a small tear that heals quickly). Therefore, when I write about acute gastrointestinal bleeding here, I’ll be referring to the emergency condition.

What Are the Symptoms of Gastrointestinal Bleeding?

Symptoms other than overt bleeding include abdominal cramps, fatigue, dizziness, weakness, anemic appearance, and shortness of breath. Stool that is black or has the consistency of tar or vomit that looks like coffee grounds are also usually due to bleeding.

In addition, acute gastrointestinal bleeding is associated with the symptoms of shock: a sudden reduction in blood pressure, a significant rise in pulse rate, and fainting. It can also affect urination, although this can be harder to notice if you’re not conscious of your normal patterns. Infrequent urination or inability to produce urine are both signs that you should seek medical help.

Current medical advice is to seek emergency care if you have symptoms of shock, vomit blood, have dark blood in your stool, or have black and tarry stool. For any other symptoms, talking to your primary care physician is considered sufficient.

Is There a Link between COVID-19 and Acute Gastrointestinal Bleeding?

In the first two years of the pandemic, COVID-19 patients receiving treatments in hospital were found to be at higher risk of acute gastrointestinal bleeding, although it is unclear whether this bleeding was due to the virus affecting the tissues of the digestive tract, the impact of the infection on pre-existing conditions, or the types of intervention used (e.g., steroids, intubation). COVID-19 patients who developed such bleeding had a poorer prognosis. COVID-19 can cause acute gastrointestinal symptoms, such as diarrhea, vomiting, abdominal pain, and loss of appetite. There are ongoing studies on possible chronic effects.

What Can Doctors Do about Gastrointestinal Bleeding?

The most important thing will be to identify where the blood is coming from. A physical, minimally invasive examination may be sufficient for bleeding coming from the mouth, throat, anus, and rectum. However, anything beyond that could require an endoscopy, gastroscopy, colonoscopy, or sigmoidoscopy. These are all terms for tests where a camera is put into the body at the end of a long tube so that doctors can examine the walls of the gastrointestinal tract for polyps, tears, ulcers, etc. These can be uncomfortable procedures and in some cases, may be done under general anesthetic. A more recent development is the capsule endoscopy: a pill-sized capsule containing a camera that takes thousands of pictures as it passes through your body.

Imaging tests can also be done: X-rays or magnetic resonance imaging (MRI) when a contrast dye has been ingested or injected and computed tomography (CT) scans all have success in finding the sources of bleeding. Blood and stool tests may also be necessary to see the impact of the bleeding on your system.

After the doctors identify the source of the bleeding, they must try to stop it. Ideally, they will want to do this without causing any more damage that also has to heal. Endoscopic surgery is preferred, and it may be done at the same time as the examination if the bleeding is severe. Special thermal devices may be used to “heat seal” the source of the bleeding. There are also special types of glue and surgical staples that can be used.

What Is an Endoscopic Hemoclip?

Introduced in 1975, the endoscopic hemoclip, sometimes called an endoscopic clip, is a very small metal medical device for closing wounds and other sources of bleeding inside the gastrointestinal tract. They can be placed anywhere from the upper part of the esophagus to the end of the large intestine. They do not interfere with the working of the organs. They don’t damage the tissue, unlike some adhesives and thermal devices.

Are Endoscopic Hemoclips a Permanent Implant?

Some hemoclips fall off and are passed from the body relatively soon after the surgery, even after just a week. Some stay in the body for several weeks or even months. In rare cases, they may be retained in the body, but this is not the intention when they are put in.

What Is the Study about?

The open access case report “Endoscopic Hemostatic Treatment for Acute Gastrointestinal Bleeding by Combined Modality Therapy with PuraStat and Endoscopic Hemoclips” focuses on the effectiveness of a method that combines a product called PuraStat with hemoclips. PuraStat reacts with blood to form a hydrogel that coats the source of bleeding. This slows or stops the loss of blood and supports blood clotting. The case report points out that clinical data on PuraStat is limited and provides information from six cases where acute gastrointestinal bleeding was successfully treated using this combination method. All six patients, including two who had gone into shock from blood loss, had the bleeding stopped and had no further bleeding.

NOTE: The paper contains photos from the surgeries described in three of the cases.

Do These Results Mean This Is the Best Method for Treating Acute Gastrointestinal Bleeding?

This case study puts forward evidence supporting the use of PuraStat plus endoscopic hemoclips to treat gastrointestinal bleeding. However, further study would be needed to determine which sources of bleeding should be treated in this way and whether there are more reliable methods.

That said, it is good to be aware of the available methods so that you can discuss them with your healthcare provider, should you ever need to.

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