Gastrointestinal Bleeding

May 2025 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Key Points

Gastrointestinal (GI) bleeding is any bleeding that occurs in the digestive or GI tract.
Medical problems in the GI tract can cause GI bleeding. Medical problems that start in other parts of the body can also cause GI bleeding.
Several medical problems that can cause bleeding in the GI tract are more common in people with Down syndrome.
GI bleeding can cause anemia and/or iron deficiency.
There are many symptoms that can indicate GI bleeding. These include noting blood (e.g., bleeding gums, blood in vomit or stool) or complications of bleeding (e.g., low blood pressure and fainting).
The cause of the GI bleeding will guide the treatment.

What is gastrointestinal bleeding?

Gastrointestinal (GI) bleeding is any bleeding that occurs in the digestive or GI tract. The GI tract starts at the mouth and ends at the anus. Blood may be seen in a person’s stool (poop) or vomit. Sometimes, bleeding occurs only in the body, and blood is not visible.

Symptoms and signs

Visible examples of bleeding include:

Bleeding gums
Blood in vomit. The blood may be red in color. It may also look like coffee grounds and have a dark brown color.
Bright red blood from the anus or only noted with wiping.
Dark or black stool.

GI bleeding can cause anemia (a low number of red blood cells) and iron deficiency (not enough iron in the blood). Anemia and iron deficiency can cause other symptoms including:

Dizziness
Fainting
Tiredness
Weakness

What can cause GI bleeding?

Several health issues may cause GI bleeding:

Gum disease
Gastroesophageal reflux disease (also called GERD or heartburn)
Celiac disease (sensitivity to gluten)
Constipation
Lactose intolerance (intolerance of the sugar in milk)
Inflammation in the GI tract. Examples include:
- Esophagitis (inflammation in the esophagus)
- Gastritis (inflammation in the stomach)
- Diverticulitis (inflammation of small bulging pouches, typically in the large intestine)
- Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis (inflammation in the small and/or large intestine)
Ulcers (erosions in the tissue lining the organ; typically, in the stomach, small intestine, or esophagus)
Cancer
And others

Why is GI bleeding important in people with Down syndrome?

Several health issues that can cause GI bleeding are more common in people with Down syndrome compared to people without Down syndrome.

Gum disease

Gum disease (periodontal disease) is more common in people with Down syndrome. It can cause bleeding gums.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is also called heartburn or reflux. It occurs when acid from the stomach goes backwards into the esophagus. GERD can cause inflammation, ulcers, and bleeding in the esophagus.

In our study of a large group of people seen in our healthcare system, esophageal disorders were 1.5 times more common in people with Down syndrome compared to people without Down syndrome.

Celiac disease

In our study, celiac disease was 18.5 times more common in people with Down syndrome compared to people without Down syndrome. Celiac disease can cause small amounts of bleeding.

Constipation

Constipation is common in people with Down syndrome. A person with constipation might strain when trying to have a bowel movement. Straining can cause hemorrhoids (swollen veins in or around the rectum) and bleeding.

Constipation can also lead to fecal impaction and rectal prolapse. Fecal impaction happens when stool becomes “stuck” inside the rectum because of constipation. Rectal prolapse happens when the rectum slides down into the anus. Both fecal impaction and rectal prolapse can cause bleeding.

Lactose intolerance

Lactose intolerance occurs when a person cannot fully digest the sugar in milk (called lactose). It may be more common in people with Down syndrome. Lactose intolerance is not a common cause of GI bleeding. Infrequently, lactose intolerance can cause irritation of the intestines and bleeding.

Ulcers

Ulcers in the stomach and duodenum (part of the small intestine) were about 1.5 times more common in people with Down syndrome in our study. These ulcers may be more common because people with Down syndrome are at greater risk of infections. Helicobacter pylori bacterial infection is a type of infection that can cause ulcers.

Pain is often the first symptom of an ulcer. However, some people with Down syndrome do not report that they are in pain, or it takes them longer than expected to report that they are in pain. If a person with Down syndrome does not complain of pain, the first symptom of an ulcer may be a fainting episode or dizziness due to severe anemia.

Inflammatory bowel disease

Inflammatory bowel disease is different than irritable bowel disease. Inflammatory bowel disease can cause GI bleeding. Crohn’s disease and ulcerative colitis are two common types of inflammatory bowel disease. They are both autoimmune diseases in which a person’s immune system attacks the intestines. When a biopsy is done of the intestine affected by inflammatory bowel disease, the tissue shows evidence of being inflamed. Crohn’s disease and ulcerative colitis may be more common in people with Down syndrome because many autoimmune diseases are more common in people with Down syndrome.

Irritable bowel disease does not typically cause bleeding, and a biopsy does not typically show inflammation.

Reduced clotting

GI bleeding can also be related to medical problems that lower the ability of blood to clot. Causes of decreased clotting ability include:

Sepsis
- Sepsis is a severe reaction to an infection that damages the body’s tissues. Sepsis can cause blood to not clot as it should.
- As noted above, infections are more common in people with Down syndrome. Infections can also be more severe in people with Down syndrome.
Thrombocytopenia
- Thrombocytopenia is a reduced number of platelets in the blood. It can occur with leukemia and other illnesses. Platelets are important for clotting.
- Leukemia is more common in children with Down syndrome.

Some health issues that children with Down syndrome may be born with or develop early in life can be associated with GI bleeding. Examples include duodenal obstruction (blockage of the first part of the small intestine) and Hirschsprung’s disease (a problem in which nerve cells are missing from the large intestine that can result in severe constipation and blockage of the large intestine). This article focuses on health issues of adults with Down syndrome, so these problems are not addressed.

Diagnosis

Tests used to determine the cause of GI bleeding include:

Blood tests
Fecal occult blood test (a test that checks for blood in a stool sample)
CT scan
GI x-rays
Procedures that use tubes and cameras to look at the GI tract (such as upper endoscopy, balloon enteroscopy, colonoscopy, or sigmoidoscopy)

A doctor may order other tests depending on a person’s symptoms.

Treatment

Treatment depends on the cause of GI bleeding. For example, if a person has GI bleeding from celiac disease, treatment will include starting a gluten-free diet. Treatments are addressed in more detail in the articles in the Resources section below.