Digestive Health Causes of Gastrointestinal Bleeding in the Esophagus By Sharon Gillson Updated on March 21, 2024 Medically reviewed by Jamie Johnson, RDN Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Bleeding in the esophagus has several possible causes. Since some bleeds can be large and fatal, you need to be evaluated by a healthcare provider for any gastrointestinal (GI) bleeding. And if you have any of the symptoms of acute GI bleeding, you should seek emergency treatment immediately. It's also important to know the symptoms of chronic GI bleeding and to see your healthcare provider if you experience them. This article breaks down possible causes and symptoms of bleeding in the esophagus. It also covers the diagnosis and treatment of GI bleeding. jose luis pelaez inc / Getty Images Symptoms of Bleeding in the Esophagus Chronic GI bleeding, meaning the bleeding is slow, persistent or keeps recurring, tends to have less obvious symptoms, since it may come out in vomit or stool in microscopic amounts. However, chronic bleeding can lead to anemia, which is when you have fewer red blood cells than you should. Symptoms of anemia include: FatigueShortness of breathWeaknessPale skinFeeling lightheaded or dizzy, faintingChest painHeadachesChills, cold hands and feetJaundice (yellowing of the skin) If you do see blood in your vomit or stool, notice black, tarry stools, or vomit what looks like coffee grounds, you should see your healthcare provider as soon as possible. Acute GI bleeding is severe and possibly sudden. If you have these symptoms, you need to seek emergency medical care: Shortness of breathWeaknessBlood in your stoolBlood in your vomitVomit that looks like coffee groundsFatigueFeeling lightheaded or dizzyConfusionDisorientationDiarrheaSleepiness Acute bleeding can send you into shock. Symptoms of shock include: Rapid pulseBlood pressure dropUnconsciousnessNot urinating often or at all Causes of Bleeding in the Esophagus There are different causes of bleeding in the esophagus, depending on whether your bleeding is chronic or acute. Causes of chronic bleeding include: Inflammation (esophagitis): Stomach acid that backs up into your esophagus can cause inflammation, and this inflammation may lead to bleeding. If it's left untreated or goes on too long, you may vomit blood or a substance that looks like coffee grounds, which is an emergency. Esophageal cancer: There are two types of esophageal cancer. Most of the length of the esophagus is lined with squamous cells, so if a malignant tumor grows here, it's called squamous cell cancer. The areas at the bottom of the esophagus, and where the esophagus joins the stomach, are lined with columnar cells. If a malignant tumor grows here, it's called adenocarcinoma. Esophageal ulcers: An ulcer can form in your esophagus if stomach acid increases or the mucous layer that coats the lining of your digestive tract decreases. Causes of esophageal ulcers include the H. pylori bacteria and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Motrin (ibuprofen), and Aleve (naproxen). Causes of acute bleeding include: Esophageal varices: Esophageal varices (enlarged veins that can rupture and bleed very easily) are very rare and usually only occur in patients with severe liver disease like cirrhosis or other conditions that affect blood flow to the liver. Tears: A tear in the lining of the esophagus is usually caused by prolonged vomiting, but may also be caused by prolonged coughing or hiccuping. This is often called Mallory-Weiss syndrome, which is a disorder of the lower end of the esophagus caused by severe retching and vomiting and characterized by laceration associated with bleeding. Diagnosing Bleeding in the Esophagus To diagnose bleeding in the esophagus, your healthcare provider may: Perform a physical exam, order blood and stool tests, and take a medical history Order an EGD (esophagogastroduodenoscopy) or an endoscopy Perform an esophageal pH test Order an upper GI series (an x-ray of the upper GI tract, including the esophagus) Treating Bleeding in the Esophagus Bleeding in the upper GI tract can most often be controlled by injecting chemical agents into the area of bleeding during an endoscopy. Cauterization of the area and surrounding tissue (using a heated probe or electrocoagulation device) is another technique to control bleeding that may be performed during an endoscopy. When your bleeding has been stopped, medication or other therapies will be prescribed to treat the underlying cause (esophagitis, ulcers, tears, etc.) and prevent a recurrence. Endoscopic treatments don't control bleeding in every case. Surgery may be needed to stop severe or recurrent bleeding when an endoscopic chemical injection or cautery has not worked. Summary Bleeding in the esophagus can have multiple causes and may be serious or even fatal. Symptoms of upper GI bleeding can include signs of anemia, blood in vomit or stool, rapid heart rate, and low/absent urine production. Diagnosis centers around a physical exam, lab testing, and scoping or upper GI X-raying. Treatment depends on the cause of the bleeding but medication is often prescribed and surgery may be necessary in serious cases. 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Kim BS, Li BT, Engel A, et al. Diagnosis of gastrointestinal bleeding: a practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5(4):467-78. doi:10.4291/wjgp.v5.i4.467 National Heart, Lung, and Blood Institute. Anemia Symptoms. Johns Hopkins Medicine. Esophagitis. Kalva NR, Tokala MR, Dhillon S, et al. An unusual cause of acute upper gastrointestinal bleeding: acute esophageal necrosis. Case Rep Gastrointest Med. 2016;2016:6584363. doi:10.1155/2016/6584363 Kapoor A, Dharel N, Sanyal AJ. Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):491-507. doi:10.1016/j.giec.2015.03.004 Johns Hopkins Medicine. Gastrointestinal Bleeding or Blood in the Stool. Additional Reading Mayo Clinic Staff. Esophageal Varices. Mayo Clinic Staff. Esophagitis. Mayo Clinic. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of GI Bleeding. U.S. Department of Health and Human Services. By Sharon Gillson Sharon Gillson is a writer living with and covering GERD and other digestive issues. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit