Related Experiment Videos
The patient with recidivent obscure gastrointestinal bleeding
1Klinik für Innere Medizin und Gastroenterologie, St.-Hildegardis-Krankenhaus, Katholisches Klinikum Mainz, Hildegardstrasse 2, 55131 Mainz, Germany. uli@heil-net.de
Best Practice & Research. Clinical Gastroenterology
|June 5, 2007
Summary
Obscure gastrointestinal bleeding requires advanced diagnostics when standard endoscopy fails. Capsule endoscopy and double balloon enteroscopy are now key for identifying bleeding sources in the mid-GI tract.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
Background:
- Obscure gastrointestinal (GI) bleeding lacks identification via standard endoscopy (oesophagogastroduodenoscopy and colonoscopy).
- GI bleeding is categorized into upper, mid-, and lower sections, with mid-GI bleeding involving the area from the Treitz ligament to the ileocaecal valve.
Purpose of the Study:
- To outline the current diagnostic approach for obscure gastrointestinal bleeding.
- To highlight the role of newer endoscopic techniques in diagnosing mid-GI bleeding.
Main Methods:
- Review of diagnostic modalities for obscure GI bleeding.
- Emphasis on capsule endoscopy and double balloon enteroscopy.
- Comparison with traditional radiological and endoscopic techniques.
Main Results:
- Standard endoscopy fails to identify bleeding sources in approximately 5% of cases.
- Capsule endoscopy and double balloon enteroscopy have become revolutionary in diagnosing obscure GI bleeding.
- Older methods like small bowel X-ray, scintigraphy, angiography, push enteroscopy, and intraoperative endoscopy are less frequently utilized.
Conclusions:
- Repeat standard endoscopy by an experienced examiner is recommended for persistent bleeding if the source is initially unidentified.
- Capsule endoscopy followed by double balloon enteroscopy (with potential intervention) is advised for persistent obscure GI bleeding.
- Intraoperative endoscopy may be necessary for patients with unstable circulation.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:23Gastritis III: Clinical Manifestations and Management
The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:25Peptic Ulcer Disease III: Clinical Manifestations and Complications
Duodenal UlcersDuodenal ulcers are the most common form of peptic ulcer disease, presenting with chronic, intermittent epigastric pain. Pain typically appears 2–3 hours after meals, especially when the stomach is empty, often waking patients at night. It is characteristically relieved by food or antacids (“pain–food–relief”). Some patients remain asymptomatic until complications like bleeding or perforation emerge, particularly with NSAID or anticoagulant use.Gastric UlcersGastric ulcers share...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Peptic ulcer disease (PUD) presents with diverse symptoms depending on the location and severity of the ulcer. Clinical manifestations of peptic ulcer include dull pain and a burning sensation in the mid-epigastric region.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:20Inflammatory Bowel Disease IV: Clinical Manifestations
Inflammatory bowel disease (IBD) encompasses two major chronic disorders—ulcerative colitis and Crohn’s disease—each characterized by relapsing episodes of gastrointestinal inflammation. Although they share certain clinical features, their patterns of involvement and manifestations differ in ways that aid diagnosis and guide management.Ulcerative ColitisUlcerative colitis is limited to the colon and rectum and involves continuous inflammation of the mucosal layer. The disease course is marked...
01:27Peptic Ulcer
Peptic ulcers are erosive lesions of the gastric or duodenal lining, most commonly caused by Helicobacter pylori infection. This Gram-negative, helical bacterium has adapted to survive the stomach’s acidic environment by producing urease, which converts urea into ammonia and carbon dioxide. The ammonia neutralizes gastric acid in the bacterium’s immediate environment, allowing colonization of the gastric mucosa. H. pylori attaches to mucus-secreting epithelial cells, penetrates the mucus...