Gastrointestinal bleeding: spot it fast and know your next move

Seeing blood in vomit or stool is scary. Gastrointestinal bleeding (GI bleed) means blood is coming from anywhere in the digestive tract — from the esophagus down to the rectum. Some bleeds are small and only show up on tests. Others are obvious: bright red blood or black, tarry stools. Knowing how to tell the difference and what to do can make a big difference.

How to recognize a GI bleed

Watch for these signs: vomiting blood or coffee-ground looking material, black sticky stools (melena), bright red blood in the toilet or on toilet paper (hematochezia), sudden dizziness, fainting, fast heartbeat, pale skin, or feeling very weak. A small, dark stool after eating iron or certain foods is different — but when in doubt, take it seriously.

Call emergency services or go to the ER if someone is vomiting a lot of blood, passing large amounts of bright red blood, fainting, or showing trouble breathing. For milder signs — dark stools without other symptoms or light bleeding — contact your doctor the same day.

Common causes and quick facts

Upper GI bleeds (esophagus, stomach, first part of small intestine) often come from peptic ulcers, gastritis, esophageal varices, or tears after severe vomiting. Lower GI bleeds (colon, rectum) commonly come from hemorrhoids, diverticulosis, inflammatory bowel disease, or colorectal polyps and cancers.

Medications matter. NSAIDs like ibuprofen, blood thinners (warfarin, direct oral anticoagulants), and some steroids raise bleeding risk. Heavy alcohol use and liver disease can cause variceal bleeding. Infections and tumors are less common but possible.

What doctors do: first they check vitals and blood tests (CBC, coagulation, type & cross). If bleeding is suspected in the upper tract, an urgent endoscopy (EGD) often finds the source and can treat it with clips, cautery, or injections. For lower bleeding, colonoscopy or CT angiography may be used. Severe bleeds might need blood transfusions and ICU care.

Medications used in hospital include IV proton-pump inhibitors for bleeding ulcers and octreotide for variceal bleeds. If you’re on blood thinners, doctors will decide whether to pause or reverse them using specific antidotes.

Prevention tips: avoid or limit NSAIDs, talk with your doctor about anticoagulant risks, treat H. pylori if you have ulcers, limit alcohol, and manage liver disease. If you have chronic stomach issues, a short course of a PPI may be advised by your clinician.

If you see blood, don’t wait. Even mild bleeding needs a checkup to find the cause and prevent a worse problem. Your doctor can guide tests and treatment so you get the right care quickly.