What is the Difference Between Upper and Lower Gastrointestinal Bleeding

The key difference between upper and lower gastrointestinal bleeding is that upper gastrointestinal bleeding is a type of gastrointestinal bleeding that usually arises from the esophagus, stomach, or duodenum, while lower gastrointestinal bleeding is a type of gastrointestinal bleeding that usually arises from the colon, rectum, or anus.

Gastrointestinal bleeding is a symptom of a disorder associated with the digestive tract. It often appears in stool or vomit and may cause the stool to look black or tarry. Moreover, the level of bleeding can range from mild to severe. It can also be life-threatening. Upper and lower gastrointestinal bleeding are two types of gastrointestinal bleeding.

CONTENTS

1. Overview and Key Difference
2. What is Upper Gastrointestinal Bleeding
3. What is Lower Gastrointestinal Bleeding
4. Similarities – Upper and Lower Gastrointestinal Bleeding
5. Upper vs Lower Gastrointestinal Bleeding in Tabular Form
6. Summary – Upper vs Lower Gastrointestinal Bleeding

What is Upper Gastrointestinal Bleeding?

Upper gastrointestinal bleeding is a type of gastrointestinal bleeding that usually arises from the esophagus, stomach, or duodenum. Upper gastrointestinal bleeding normally affects around 50 to 150 per 100,000 people a year. It accounts for over 50% of cases of gastrointestinal bleeding. Depending on the severity of upper gastrointestinal bleeding, it carries an estimated mortality risk of 11%.

Upper gastrointestinal bleeding may be caused by gastric erosions, esophageal varices, peptic ulcers, Mallory-Weiss tear, gastric cancer, gastritis, Dieulafoy’s lesion, duodenal cancer, etc. The signs and symptoms of this gastrointestinal bleeding include hematemesis, coffee-ground vomiting, melena, anemia, chest pain, syncope, shock, fatigue, and shortness of breath. Diagnosis of upper gastrointestinal bleeding includes measurement of the blood pressure, heart rate, and blood tests to determine haemoglobin.

Furthermore, a significant amount of upper gastrointestinal bleeding is considered a medical emergency. Therefore, the treatment options for upper gastrointestinal bleeding include fluid replacement, blood transfusion, medications like proton pump inhibitors (reduce gastric acid production), tranexamic acid (for peptic ulcers), and medical procedures such as transjugular intrahepatic portosystemic shunt and surgery.

What is Lower Gastrointestinal Bleeding?

Lower gastrointestinal bleeding is a type of gastrointestinal bleeding that typically occurs from the colon, rectum, or anus. Lower gastrointestinal bleeding accounts for 20% to 30% of all patients presenting with major gastrointestinal bleeding. The causes of lower gastrointestinal bleeding may include diverticular disease, inflammatory bowel disease (IBD), tumors, colon polyps, haemorrhoids, anal fissures, and proctitis. Moreover, lower gastrointestinal bleeding signs and symptoms may include bright red blood drops, smears or clots in the stool, abdominal cramps and pain, faintness or dizziness, unexplained weakness, unusual paleness, and shortness of breath.

Lower gastrointestinal bleeding can be diagnosed through medical history, physical findings, laboratory findings (complete blood count), anoscopy, flexible sigmoidoscopy, colonoscopy, barium enema, and radiologic studies. Furthermore, the treatment options for lower gastrointestinal bleeding include oxygen administration, intravenous fluid, a low-dose aspirin for prevention of heart attack, dual antiplatelet therapy, vasoconstrictive therapy, super selective embolization, endoscopic therapy surgical intervention (subtotal removal of the colon).

What are the Similarities Between Upper and Lower Gastrointestinal Bleeding?

• Upper and lower gastrointestinal bleeding are two types of gastrointestinal bleeding.
• Both conditions may show similar symptoms, such as bloody stool, anemia, shortness of breath, etc.
• Both conditions can cause life-threatening complications.
• They can be diagnosed through laboratory tests and endoscopy.
• They can be treated through specific medications and surgeries.

What is the Difference Between Upper and Lower Gastrointestinal Bleeding?

Upper gastrointestinal bleeding usually arises from the esophagus, stomach, or duodenum, while lower gastrointestinal bleeding usually arises from the colon, rectum, or anus. Thus, this is the key difference between upper and lower gastrointestinal bleeding. Furthermore, upper gastrointestinal bleeding accounts for over 50% of cases of gastrointestinal bleeding. On the other hand, lower gastrointestinal bleeding accounts for over 20% to 30% of cases of gastrointestinal bleeding.

The below infographic presents the differences between upper and lower gastrointestinal bleeding in tabular form for side-by-side comparison.

Summary – Upper vs Lower Gastrointestinal Bleeding

Gastrointestinal bleeding is caused by a disorder digestive tract. Upper and lower gastrointestinal bleeding are the two main types of gastrointestinal bleeding. Upper gastrointestinal bleeding usually starts from the esophagus, stomach, or duodenum, while lower gastrointestinal bleeding usually starts from the colon, rectum, or anus. Melena is a common symptom of upper gastrointestinal bleeding, which causes black, tarry, sticky stools. Hematochezia is a common symptom of lower gastrointestinal bleeding, which causes bright red colour blood in or with stools. So, this summarizes the difference between upper and lower gastrointestinal bleeding.

Reference:

1. Kamboj, Amrit K., et al. “Upper Gastrointestinal Bleeding: Etiologies and Management.” Mayo Clinic Proceedings, Elsevier, 1 Apr. 2019.
2. “Lower GI Bleeding.” American College of Gastroenterology, 21 Sept. 2021.

Image Courtesy:

1. “Esophageal varices being banded, showing white ball sign and wale sign” By Samir – I created this work entirely by myself. (CC BY 3.0) via Commons Wikimedia
2. “Algorithm for lower GI Bleed” By Tarek – Own work (CC BY-SA 4.0) via Commons Wikimedia