Introducing GIST and Dieulafoy - Think of Them in GI Bleeding and Anemia

Common presentations of gastrointestinal bleeding include hematemesis, melena, and history of dizziness, fatigue, or syncope; yet, bleeds may present in many uncommon ways. This review discusses two cases of gastrointestinal bleeds (GIBs) in middle-aged female patients who presented with anemia and recurrent unexplained GIBs. Both patients were misdiagnosed for several years before the cause of their bleeding was established. Dieulafoy lesion is said to be rare, although its precise incidence is difficult to establish due to its anatomically inaccessible location, small size, and lack of symptoms prior to presentation. This condition can result in gastrointestinal hemorrhage and quickly pose life-threatening complications. Gastrointestinal stromal tumors (GISTs) are likewise difficult to diagnose due to their location in the submucosa and lack of good diagnostic tools. Depending on tumor size, location, and spread, GISTs can have a poor prognosis even with early intervention. By presenting the two cases, this review aims to bring attention to Dieulafoy lesion and GIST as arguably not-so-rare but potentially fatal sources of GIBs. Especially troublesome is the uncommon complication of GIST to perforate and the elusive nature of Dieulafoy lesions that require diligent evaluation. For these reasons, both should be considered in the differential diagnosis in patients with recurrent unexplained GIBs and anemia.