How Are Gastrointestinal Bleeding and Sepsis Connected?

What do gastrointestinal bleeding and sepsis have in common? On the face of it, it may seem like not much, however, if you have a hole in your gastrointestinal (GI) tract, you could develop an infection and that could lead to sepsis. And, there is the opposite scenario. Some patients in septic shock can develop an upper GI bleed, likely because of the decreased blood flow to the area, resulting in erosion or destruction of the tissue.

There is another group of patients that should be monitored for gastrointestinal bleeding: those with acute coronary syndrome (ACS). If someone with ACS gets sepsis, they have a higher risk of having a GI bleed. Researchers from a study published in 2018 wrote that sepsis and bleeding “may reinforce each other, which may aggravate the situation and may even cause death in serious cases.”

What Is a Gastrointestinal Bleed?

Your GI system, also called your digestive system, runs from your esophagus, where your food and drink goes down to your stomach, to your anus. Any puncture or hole along that system can cause a GI bleed. If the bleed occurs in the upper GI tract (esophagus, stomach and upper part of the small intestine), you may vomit fresh or brownish blood or the blood may pass down into your stool. But in this case, blood from the upper GI tract doesn’t look like fresh blood. It will look tarry or like coffee grounds. If the bleed is in the lower GI tract, it may also look tarry or dark, but the closer to the anus the bleed is, the fresher or redder the blood might look.

A GI bleed isn’t a condition or disease, but the symptom of one. You can have an acute bleed – one that occurs quickly and suddenly, or a chronic bleed. A chronic GI bleed may come and go and usually isn’t severe. It still should be investigated though, because your doctor needs to know why it’s occurring and if left for too long, a chronic bleed can cause other complications like anemia.

How Do GI Bleeds Occur?

There are many causes for a GI bleed, depending on where it is. The most common causes of an upper GI bleed include:

• Peptic ulcers, usually caused by H.pylori infection
• Tears in the esophagus, often caused by excessive use of alcohol
• Esophageal varices, enlarged veins in the esophagus, often the result of serious liver disease
• Esophagitis, inflammation of the esophagus, often caused by gastroesophageal reflux disease (GERD)

You could also develop a perforation in your upper GI tract if you take certain types of medications, such as ASA (Aspirin) and nonsteroidal anti-inflammatory drugs, NSAIDS, including ibuprofen. Other drugs can increase your risk of bleeding overall, such as anticoagulants (blood thinners).

Lower GI bleeds can occur because of:

• Diseases in the gut, such as diverticular disease and inflammatory bowel disease (IBD)
• Tumors in the colon or rectum
• Colon polyps, groups of cells found on the intestinal lining
• Hemorrhoids
• Anal fissures, small tears in the anus lining
• Proctitis, inflammation of the lining of the rectum

A bleed can also be caused by food poisoning, infections, even trauma from surgery or a surgical procedure.

Symptoms of Gastrointestinal Bleeding

If you have an acute GI bleed, symptoms come on fast. You may start vomiting blood or “coffee grounds” or you might have dark, tarry stools. In addition you may have:

• Abdominal pain
• Chest pain
• Difficulty breathing
• Dizziness
• Fainting

If the bleeding isn’t stopped, you could go into shock, which means your blood pressure drops and  your heart rate speeds up. You may also notice that you’re not urinating as much or as frequently.

If you have a chronic bleed, you could also have some of the above symptoms, but they might be harder to pinpoint because they may be more gradual or subtle. Some people discover they have a chronic bleed if their blood tests show they have anemia and their doctor investigates to find out why.

Treatment for Gastrointestinal Bleeding

The good news is most of the time, GI bleeding can be treated, once the cause is discovered. In some cases, the doctor inserts a scope through the mouth or anus, and can use tools to seal the hole or inject medication to close it. If the hole is too big or difficult to find, or was caused during a surgical procedure, surgery will be necessary.

So, What Can You Do?

Speak with your doctor if you have any signs of a GI bleed or if you are concerned about developing one. Whenever you take a new medication, even over-the-counter, speak with your pharmacist to ensure that it is safe for you to take. And watch for signs of sepsis, particularly if you are at risk for a GI bleed. If you suspect sepsis, go to your closest emergency room or call 911 and say that you are concerned about sepsis.