Gastrointestinal Bleeding as a Complication of Cirrhosis

Gastrointestinal bleeding is common among people with cirrhosis due to a complication called portal hypertension. This is elevated blood pressure in the veins that lead to your liver.

Cirrhosis is severe and permanent scarring of your liver. It’s also called end-stage liver disease because it’s the most severe form of liver damage.

It’s estimated that more than half a million people in the United States have cirrhosis. Cirrhosis has many causes, but heavy alcohol use and viral infections are among the most common.

Portal hypertension, meanwhile, raises your risk of developing conditions like stomach and esophageal varices that can lead to bleeding. Gastrointestinal bleeding is a serious medical condition that requires prompt medical attention. If left untreated, it can be life threatening.

In this article, we take a deeper look at the relationship between cirrhosis and gastrointestinal bleeding.

Portal hypertension is a potentially life threatening complication of cirrhosis. It develops when scarring and changes to the blood vessels in your liver cause blood to back up in the veins that lead to your liver. Almost 90% of people with cirrhosis develop portal hypertension.

Portal hypertension is linked to a number of conditions that can lead to gastrointestinal bleeding, especially in your upper gastrointestinal tract. Your upper gastrointestinal tract is the region from your mouth to the first part of your small intestines.

Esophageal and stomach varices

Stomach and esophageal varices (singular: varix) account for about 60% to 65% of cases of gastrointestinal bleeding in people with cirrhosis. Varices are expanded sections of blood vessels caused by high blood pressure. They can bleed if they break open. A bleeding gastrointestinal varix is a medical emergency that requires immediate medical attention.

Varices account for 25% to 50% of deaths in people with advanced cirrhosis. There’s about a 10% to 30% chance that varices will rupture within the first year after cirrhosis diagnosis, and the death rate is close to 20% when they rupture.

Portal hypertensive gastropathy

Portal hypertension can also lead to portal hypertensive gastropathy, which is characterized by changes in the mucous membrane lining your stomach due to changes in your blood pressure. It accounts for about 10% of cases of gastrointestinal bleeding in people with cirrhosis.

In severe cases, portal hypertensive gastropathy can cause anemia and be life threatening. Anemia is a low red blood cell count.

Lower gastrointestinal bleeding

Although less common than upper gastrointestinal bleeding, cirrhosis can also cause lower gastrointestinal tract bleeding due to changes in the mucosal membrane of your intestines.

Limited available research suggests that the most common sources of lower gastrointestinal bleeding in people with cirrhosis are:

• hemorrhoids (most common)
• colon, rectal, or anal varices
• enteropathy (inflammation of the small intestines)
• vascular ectasia (weakening of blood vessels)
• diverticula (bulging areas of your digestive tract)

The main diagnostic test for suspected gastrointestinal bleeding is endoscopy. Endoscopy involves passing a long, thin tube through either your mouth or your anus, depending on which part of your gastrointestinal tract is suspected to be bleeding.

Your doctor may also order imaging tests, such as:

• abdominal computed tomography scans
• angiogram
• radionuclide scan
• X-rays with barium swallow or barium enema (less common)

Blood tests or stool tests may also be used to support a diagnosis.

Along with being a diagnostic tool, endoscopy can also be used to treat bleeding. Endoscopic therapy can stop bleeding in about 90% of people with varices in their stomach or esophagus.

Endoscopic techniques that can be used to stop bleeding include:

• Injection sclerotherapy: A surgeon uses an endoscope to inject a substance into varices to help the affected veins shrink. It usually only requires a small injection.
• Variceal ligation: The surgeon uses an endoscope to attach elastic bands to enlarged veins to stop bleeding.
• Self-expanding stents: A surgeon endoscopically places a stent into a bleeding blood vessel to allow blood to pass through the blood vessel without leaking. A stent is an artificial tube that keeps a blood vessel open.
• Shunts: Doctors can divert blood flow between your blood vessels with a shunt. A shunt is an artificial passage for carrying blood.

Endoscopic techniques are often combined with medications to reduce pressure in your portal vein and antibiotics to prevent infection. Medications like terlipressin and somatostatin may be administered for 5 days after endoscopic treatment.

Liver transplantation is the only potential cure for cirrhosis and portal hypertension. Liver transplantation involves surgically replacing your liver with a liver from a deceased donor or a part of a liver from a living donor.

Cirrhosis can lead to many other complications besides gastrointestinal bleeding. Most of these complications are also linked to portal hypertension.

• ascites, or a fluid buildup in your abdomen
• hepatic encephalopathy, or altered consciousness due to liver failure
• buildup of fluid in your lungs
• hepatocellular carcinoma, the most common type of liver cancer
• reduced oxygen saturation of your red blood cells
• acute kidney failure caused by liver failure
• high blood pressure in your lungs

It’s very important to see your doctor if you have signs of gastrointestinal bleeding, whether you have been previously diagnosed with cirrhosis or not. Gastrointestinal bleeding can be life threatening and requires immediate medical attention.

Symptoms of gastrointestinal bleeding can include:

• black and tarry stools
• bright red blood in vomit
• dizziness or lightheadedness
• fatigue
• paleness
• vomit that looks like coffee grounds
• weakness

• has a sudden drop in blood pressure
• experiences little to no urination
• falls unconscious
• has a rapid pulse

Gastrointestinal bleeding is a common complication of cirrhosis. It’s usually caused by varices, which are areas in your gastrointestinal tract where blood vessels rupture due to increased blood pressure. They can usually be treated with local treatments to stop the bleeding and medications to lower blood pressure in your portal vein.

It’s critical to get immediate medical attention if you suspect you may have gastrointestinal bleeding to prevent potentially life threatening complications.

Last medically reviewed on April 13, 2023