Causes of Gastrointestinal Bleeding in the Esophagus

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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.

Doctor examining neck of patient
 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:

  • Fatigue
  • Shortness of breath
  • Weakness
  • Pale skin
  • Feeling lightheaded or dizzy, fainting
  • Chest pain
  • Headaches
  • Chills, cold hands and feet
  • Jaundice (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 breath
  • Weakness
  • Blood in your stool
  • Blood in your vomit
  • Vomit that looks like coffee grounds
  • Fatigue
  • Feeling lightheaded or dizzy
  • Confusion
  • Disorientation
  • Diarrhea
  • Sleepiness

Acute bleeding can send you into shock. Symptoms of shock include:

  • Rapid pulse
  • Blood pressure drop
  • Unconsciousness
  • Not 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:

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.
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  2. National Heart, Lung, and Blood Institute. Anemia Symptoms.

  3.  Johns Hopkins Medicine. Esophagitis.

  4. 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

  5. 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

  6. Johns Hopkins Medicine. Gastrointestinal Bleeding or Blood in the Stool.

Additional Reading

By Sharon Gillson
 Sharon Gillson is a writer living with and covering GERD and other digestive issues.