New insights to occult gastrointestinal bleeding: From pathophysiology to therapeutics

Abstract

Obscure gastrointestinal bleeding is still a clinical challenge for gastroenterologists. The recent development of novel technologies for the diagnosis and treatment of different bleeding causes has allowed a better management of patients, but it also determines the need of a deeper comprehension of pathophysiology and the analysis of local expertise in order to develop a rational management algorithm. Obscure gastrointestinal bleeding can be divided in occult, when a positive occult blood fecal test is the main manifestation, and overt, when external sings of bleeding are visible. In this paper we are going to focus on overt gastrointestinal bleeding, describing the physiopathology of the most usual causes, analyzing the diagnostic procedures available, from the most classical to the novel ones, and establishing a standard algorithm which can be adapted depending on the local expertise or availability. Finally, we will review the main therapeutic options for this complex and not so uncommon clinical problem.

Keywords: Angiodysplasia; Double balloon enteroscopy; Obscure gastrointestinal bleeding; Wireless capsule endoscopy.

Figure 1

Proposal of a diagnostic algorithm. OGIB: Obscure gastrointestinal bleeding; WCE: Wireless capsule endoscopy; DBE: Double balloon enteroscopy; PE: Push enteroscopy; IE: Intraoperative enteroscopy.