The evaluation and management of obscure and occult gastrointestinal bleeding

Vijay Singh, Jeffrey A. Alexander

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations

Abstract

Gastrointestinal (GI) bleeding is a common clinical presentation increasing in an aging population, frequently requiring hospitalization and emergent intervention, with significant morbidity, mortality, and costs. It may manifest overtly as hematemesis, melena, or hematochezia, or as an asymptomatic occult bleed. Management typically involves an esophagogastroduodenoscopy or a colonoscopy; these in combination sometimes do not identify a source of bleeding, with the source remaining obscure. Further work up to identify an obscure source frequently requires radiologically detecting the leakage of an intravascular tracer (using tagged red blood cells or angiography) with brisk bleeding or in other cases CT enterography (CTE) to detect bowel wall changes consistent with a bleeding source. Recent advances including capsule endoscopy, CTE, and double-balloon endoscopy have helped to identify bleeding sources beyond the reach of conventional endoscopy. Clinical decision-making about their use is complex and evolving. Knowing their relative merits and weaknesses including yield, contraindications, complications, and cost is essential in coming up with an appropriate management plan. This review covers the rationale for clinical management of obscure sources of GI bleeding, mentioning the approach to and the yield of conventional methods, with an emphasis on the recent advances mentioned above.

Original languageEnglish (US)
Pages (from-to)311-319
Number of pages9
JournalAbdominal Imaging
Volume34
Issue number3
DOIs
StatePublished - Jun 1 2009

Keywords

  • Gastrointestinal bleeding
  • Management
  • Obscure
  • Occult
  • Review

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Fingerprint Dive into the research topics of 'The evaluation and management of obscure and occult gastrointestinal bleeding'. Together they form a unique fingerprint.

Cite this