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Evaluation of occult gastrointestinal bleeding.
Kathy Bull-Henry1, Firas H Al-Kawas
1Department of Medicine, Georgetown University Hospital, Washington, DC 20007, USA. kpb3@gunet.georgetown.edu
American Family Physician
|April 4, 2013
Summary
Occult gastrointestinal bleeding, often undetected, requires a stepwise diagnostic approach. Advanced imaging like capsule endoscopy aids in identifying the source when initial tests are inconclusive.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Occult gastrointestinal bleeding (OGIB) presents as undetectable bleeding, leading to iron deficiency anemia or a positive fecal occult blood test.
- Accurate diagnosis is crucial for patient management and preventing complications.
Purpose of the Study:
- To outline a systematic evaluation strategy for identifying the sources of occult gastrointestinal bleeding.
- To detail the diagnostic yield of various endoscopic and imaging modalities.
Main Methods:
- The evaluation begins with fecal occult blood testing and assessment for iron deficiency anemia.
- Initial endoscopic procedures include esophagogastroduodenoscopy (EGD) and colonoscopy.
- Further investigations involve capsule endoscopy and deep enteroscopy for persistent or obscure bleeding.
Main Results:
- EGD and colonoscopy detect bleeding sources in 48-71% of patients; repeat procedures can identify missed lesions in 35%.
- Capsule endoscopy offers a 61-74% diagnostic yield when initial endoscopic evaluations are negative.
- Deep enteroscopy provides further visualization and therapeutic intervention in the small bowel.
Conclusions:
- A stepwise diagnostic approach, incorporating EGD, colonoscopy, and advanced imaging, is effective in diagnosing OGIB.
- Specific patient populations, including those with iron deficiency anemia, require thorough investigation regardless of initial test results.
- Attributing positive tests to medications like aspirin or anticoagulants should only occur after comprehensive evaluation.
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