Melena

Melena is black, tar-like stool that is most often caused by bleeding in the upper gastrointestinal tract. The blood turns black and tarry as it travels through the digestive tract from its upper part (usually the stomach or duodenum). Digestive juices interact with the blood, changing its color and consistency.

What causes melena?

Melena results from bleeding in the upper gastrointestinal tract—usually in the stomach or the upper part of the small intestine. In rare cases, melena may originate in the lower part of the small intestine or the upper part of the large intestine. Causes of bleeding in the upper gastrointestinal tract:

• Peptic ulcer (a bleeding ulcer in the stomach or duodenum);
• Severe inflammation (gastritis or esophagitis);
• Erosion of the stomach lining (acute hemorrhagic erosive gastropathy);
• Trauma or perforation of the gastrointestinal tract;
• Swelling and rupture of veins in the esophagus or stomach;
• Rupture of the esophagus due to severe vomiting;
• Cancer of the stomach, esophagus, or pancreas;
• Viral hemorrhagic fevers, such as Ebola.

What are other causes of melena?

• Iron supplements;
• Activated charcoal;
• Foods: e.g., black licorice or blueberries.

What other symptoms occur along with melena?

• Abdominal pain may indicate a stomach disorder, such as an ulcer, gastritis, or gastropathy;
• Chest pain may be associated with esophageal disease;
• Pancreatic disorders can cause upper abdominal pain or back pain.

Some people with bleeding in the upper gastrointestinal tract also vomit blood. Fresh, red blood in the vomit indicates active bleeding in the stomach or esophagus.

What tests are performed to diagnose melena?

• Medical history and physical examination: To diagnose melena, the doctor will ask about your symptoms, their onset, course, family history, and risk factors, and will perform a digital rectal exam;
• Laboratory tests: a complete blood count, blood chemistry panel, urinalysis, and stool test can provide additional information about your health;
• Abdominal X-ray: may reveal signs of intestinal obstruction or free air;
• Computed tomography (CT): used to more accurately locate the source of bleeding, especially in more complex cases;
• Fibrogastroduodenoscopy (FGDS): the primary test that allows for direct visualization of the upper gastrointestinal tract, identification of the bleeding site, and, if necessary, immediate control of the bleeding.

What is the treatment for melena?

• Treatment of blood loss—depending on the amount of blood lost, intravenous fluids or a blood transfusion may be needed to restore blood volume. Some people may require intensive care before further testing or treatment;
• Stopping the bleeding—a doctor can often stop active bleeding and prevent new bleeding during a fibrogastroduodenoscopy. During the procedure, bleeding can be stopped by: injections of epinephrine, electrocoagulation, sclerotherapy or laser therapy;
• Treatment of the cause of bleeding—acid-blocking medications called proton pump inhibitors (PPIs), which are often prescribed to treat ulcers, inflammation, or erosion of the stomach and intestinal lining. These promote healing and help protect tissues from chemical damage. Some causes of melena require more extensive treatment.

When should I be concerned and see a doctor about melena?

If your stool appears tarry or sticky and has a strong odor, it may be melena. Melena indicates bleeding in the digestive tract. Internal bleeding is always serious, especially when you cannot tell if it has stopped.