Gastrointestinal Bleeding

Overview

Several conditions can change your intestinal lining and cause intestinal bleeding. The bleeding can be slow and unnoticeable, or fast (hemorrhage) with obvious signs of blood in the stool. Tumors, polyps, ulcers and other abnormalities in the lining of your intestines can cause chronic gastrointestinal (GI) bleeding that over time can make you feel weak and cause anemia.

• Arteriovenous malformations (AVMs). Many cases of small bowel bleeding result from arteriovenous malformations (AVMs). AVMs refer to tiny clusters of blood vessels where arteries and veins intertwine. Most people with AVMs never know they have the condition. Others experience symptoms as they age or as the result of taking medicines to treat heart valve abnormalities and kidney disease.
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Benign and malignant small bowel tumors
• Polyps and ulcers

These abnormalities can result from cancers, medicines taken to treat other ailments and/or part of existing conditions, such as Crohn’s disease or ulcerative colitis.

Diagnosis

When physicians cannot locate the source of the bleeding by using upper endoscopy, sigmoidoscopy, or colonoscopy, they use balloon enteroscopy to examine the most difficult-to-reach parts of your small bowel. The program is the only one of its kind in Indiana. IU Health enteroscopy services pioneer new uses and therapies to diagnose, treat and manage your symptoms.

Symptoms

With GI bleeding, your body loses a small amount of blood every day. Over time, this can cause the following symptoms:

• Anemia
• Fatigue
• Shortness of breath
• Dizziness
• Heart palpitations
• Blood in stools
• Hemorrhage

Symptoms of anemia could indicate gastrointestinal bleeding.

Treatment

At IU Health, your physicians lead research and clinical trials, which enables them to give you the most advanced treatments available. In some instances, therapy with a balloon-assisted scope can help you avoid surgery.

IU Health’s affiliation with the Indiana University School of Medicine and the Division of Gastroenterology and Hepatology gives physicians access to many gastrointestinal experts and a multidisciplinary approach to diagnosing and treating your gastrointestinal bleeding including:

• Double balloon or deep enteroscopy. When physicians cannot determine the cause of your bleeding by endoscopy, your gastroenterologist may use double balloon enteroscopy to find the source of your bleeding. This procedure lets your physician examine difficult-to-reach parts of your small bowel. A double balloon enteroscopy uses a long tube equipped with a camera that pushes deeper into your intestines as the attached balloons inflate and deflate. Learn more about double balloon enteroscopy at IU Health.
• Balloon enteroscopy. Physicians use balloon enteroscopy to examine, diagnose and treat the bleeding. If your physician finds lesions, they can cauterize them immediately. With this procedure, they can mark the location of an abnormality for future surgery and remove tumors and biopsies.
• Cauterizing bleeding. Balloon enteroscopy allows your physician to treat and cauterize ulcers and bleeding lesions in your small intestine during the procedure. A long tube (endoscope) equipped with a camera enters your small bowel through your upper or lower gastrointestinal tract. By inflating and deflating the attached balloons, the small bowel is gathered and pleated over an insertion tube, in the way a curtain goes over a curtain rod.
• Biopsy. During a balloon enteroscopy, your physicians take samples from tissues, tumors and polyps for further study or cancer staging.
• Polyp removal. Your physician can resect polyps and other masses from your small intestine during an enteroscopy.
• Tattooing. Your physician may mark, or tattoo, an area of your small intestine for later surgery or further investigation.
• X-rays. While your physician conducts the balloon enteroscopy procedure, he or she will take pictures and possibly videos of your small intestine to document any areas of concern.
• Medicines. For gastrointestinal bleeding caused by inflammatory bowel disease (Crohn’s disease or ulcerative colitis) and ulcers, medicines can help reduce inflammation and heal areas of your intestinal lining.
• Clinical studies. At IU Health, we maintain a database of all double balloon enteroscopies. We study the results of these procedures to determine if and how we make a difference for patients, especially when it comes to treating bleeding of the small intestine.