Bleeding, also known as a hemorrhage, is defined as loss of blood from the body through the skin, blood vessels, or any opening like the nose, mouth, vagina, or rectum. There are several causes of bleeding, the major one being trauma. Other factors include infection, swelling, vitamin K deficiency, menorrhagia, and cancer. Hereditary tendency to bleed is common in males called ‘Hemophilia’, a common bleeding disorder. Bleeding from the nose is called ‘epistaxis’. Bleeding from the intestine is called ‘gastrointestinal bleeding’. GI bleeding is not a disease, but a symptom of a disease that is further separated into two categories i.e. ‘upper and lower GIT bleeding’. The demarcation between the upper and lower GI tract is the duodenojejunal junction (ligament of Treitz)

Both these types have differences and similarities so the following article shows key differences between upper and lower GIT bleeding.

Difference between Upper and Lower Gastrointestinal Bleeding

Upper GIT Bleeding

Bleeding from any pathology in the esophagus, stomach, or second part of the duodenum is called ‘upper GIT bleeding’ i.e above ligament of Treitz. Bleeding from upper GIT can be further divided into two categories. First is called ‘hematemesis’ which means vomiting of blood and second is ‘Melena’ which is defined as the passage of dark-colored stools. This tarry appearance is due to oxidation of iron in hemoglobin as it passes through ileum and colon.

If there is rapid and continuance bleeding going on in the GIT, it presents as hematemesis whereas if the bleeding is gradual and in small amount, it presents as melena. Melena can develop even after a small amount of blood loss which may be up to 50 to 100 ml. The appearance of vomited blood depends upon how long the blood was in your GI system. If the blood does not come out of the body and remains in the stomach; it appears brown in the vomit as the iron is oxidized by gastric acid with the presence of clotted blood. This is called ‘coffee ground vomiting’. Bright red blood indicates active bleeding which is considered as a medical emergency. Dark, granular blood indicates slow bleeding (coffee ground).

Lower GIT Bleeding

Lower GIT bleeding is defined as bleeding occurring from the 3rd part of the duodenum and large intestine which consists of ileum, colon, rectum, and anal canal. The most common site is the colon and anorectal area. It is also called ‘Hematochezia’ which means passage of bright red blood through the rectum. Its etiology varies depending upon the age of the patient, nature, and severity of bleeding. Based on the age it is grouped into two categories i.e. patient below 50 years and above 50 years. Malignancy is the leading cause of bleeding in old age patients whereas the common cause among young patients includes anorectal disorders, specifically, hemorrhoids. The second category is bleeding with or without pain. Other important factors include the appearance and duration of bleeding and bleeding before or after the passage of stool. If a patient presents with lower GIT bleeding, he should be evaluated for infections, tumors, inflammation, and ischemia.

Upper VS Lower GIT Bleeding

  • Incidence:

Upper GI bleed is more common than lower GI bleed.

  • Location:

Upper GIT bleeding is from the esophagus, stomach, and duodenum proximal to the ligament of Treitz.

Lower GIT bleeding is distal to the ligament of Treitz and colon.

  • Color of blood:

In upper GI bleed the color depends on where the bleeding is. It presents with black tarry stools (melena), vomiting of fresh blood (hematemesis), and vomiting of dark altered blood (coffee ground emesis)

Lower GIT bleed shows bright red blood per rectum.

  • Causes:

Upper GIT bleeding is associated with stomach and duodenal ulcers, esophagitis, esophageal and gastric varices, Mallory-Weiss tears, and carcinoma.

Lower GIT bleeding is most commonly caused by upper GIT bleeding further associated with diverticular diseases, anorectal diseases that include piles, fissures, and fistula, inflammatory bowel diseases, drugs (NSAIDs), and cancer.

  • Symptoms:

Patient with Upper GIT bleeding feels weak, fatigued, nauseated with low blood pressure and rapid pulse. Other signs of shock include cool extremities, chest pain, confusion, delirium.

Patient with Lower GIT bleeding is generally in a stable condition as there is no rapid and massive bleeding.

  • Diagnosis:

Upper GI investigations include upper GIT endoscopy, angiography, and radionuclide scan.

Lower GIT investigation includes an abdominal and digital rectal examination. The diagnostic studies include sigmoidoscopy, colonoscopy, CT angiography, and Technetium Scan.

  • Treatment:

Upper GIT bleeding is treated through administration of octreotide, vasopressin, proton pump inhibitor, and surgery. Treat if positive for H.pylori.

Lower GIT bleeding is treated through transfusion, vasopressin, and surgery.

Conclusion

Given the nature of GI bleed, it is necessary to differentiate UGIB and LGIB as the presentation varies from mild to severely ill patients that require immediate intervention.  It’s important to comprehend the state and begin effective management, especially in acute cases. A person may have upper or lower GIT bleeding which is investigated thoroughly and treated according to the underlying factor.