[Gastrointestinal hemorrhage: how much evaluation is necessary?]

Area of Science:

• Gastroenterology
• Hematology

Context:

• Analysis of 362 patients over 10 years (1979-1989) at a medical outpatient clinic.
• Patients referred for evaluation of incidental iron deficiency anemia or suspected gastrointestinal bleeding (melena/hematemesis).

Purpose:

• To investigate the diagnostic yield of investigations for gastrointestinal bleeding and iron deficiency anemia.
• To identify the causes of gastrointestinal bleeding and iron deficiency in a patient cohort.

Summary:

• Gastrointestinal (GI) malignancies were identified in 7% of patients (n=25), with occult fecal blood detected in 80% of these cases.
• Benign GI lesions were found in 26% (n=95), while 26% (n=88) had normal endoscopic findings.
• In 42% of patients (n=154), extensive investigations, including repeated endoscopy, failed to determine the cause of blood loss.
• Iron deficiency anemia causes included hypermenorrhea (13%) and other non-GI origins (13%).
• Severe iron deficiency (hemoglobin < 10 g/dl) was associated with a positive hemoccult test in 90% of cases.

Impact:

• Highlights the diagnostic challenges posed by gastrointestinal bleeding of undetermined etiology for general practitioners.
• Underscores the need for comprehensive diagnostic strategies in patients with unexplained iron deficiency anemia and GI bleeding symptoms.