Gastroenterology

Gastroenterology

Volume 133, Issue 5, November 2007, Pages 1697-1717
Gastroenterology

AGA Institute
American Gastroenterological Association (AGA) Institute Technical Review on Obscure Gastrointestinal Bleeding

https://doi.org/10.1053/j.gastro.2007.06.007Get rights and content

This literature review and the recommendations therein were prepared for the AGA Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on March 12, 2007, and by the AGA Institute Governing Board on May 19, 2007.

Section snippets

Etiology

Causes of obscure GI bleeding may potentially include any lesion from the oral cavity to the anorectum that may bleed into the GI tract (see Table 1). To date, there are no longitudinal or population-based studies on the frequency and location of specific causes of obscure GI bleeding.

Commonly overlooked lesions in the upper GI tract include Cameron’s erosions in large hiatal hernias,6 fundic varices,7, 8 peptic ulcer disease, angioectasias,6 Dieulafoy’s lesion,9 and gastric antral vascular

History and Physical Examination

The importance of a thorough history and physical examination cannot be overemphasized in the evaluation of a patient with obscure GI bleeding. The nature of the exact presenting symptom is important in deciding a practical, efficient, and cost-effective evaluation plan. For example, recurrent hematemesis from an unknown source usually signifies a bleeding lesion above the ligament of Treitz, and lower GI evaluations are generally not warranted in such a scenario. Severity and temporal pattern

Cost

The current medical literature lacks sufficient information concerning the costs associated with diagnosing obscure GI bleeding. The most comprehensive review of the economic literature for the period from 1985 to 1995 has limited information of value in understanding the costs and was not limited to obscure bleeding.157

There are various issues that contribute to the medical costs incurred in these patients. It may take considerable time to diagnose a patient with obscure bleeding. The median

Management

The American Gastroenterological Association medical position statement concerning the evaluation and management of obscure GI bleeding was published in January 2000, before the initial studies utilizing capsule endoscopy and DBE.1 The position statement proposes progressive testing with bleeding scans and angiography for those patients with active bleeding, as well as repeat endoscopy, enteroscopy, enteroclysis, or small bowel series for those not actively bleeding. With continued blood loss,

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