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Review
. 2014 Nov 15;5(4):467-78.
doi: 10.4291/wjgp.v5.i4.467.

Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

Bong Sik Matthew Kim  1 , Bob T Li  1 , Alexander Engel  1 , Jaswinder S Samra  1 , Stephen Clarke  1 , Ian D Norton  1 , Angela E Li  1
Affiliations
Review

Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

Bong Sik Matthew Kim et al. World J Gastrointest Pathophysiol. .

Abstract

Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is not apparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.

Keywords: Angiography; Capsule endoscopy; Colonoscopy; Computed tomography; Diagnostic techniques; Endoscopy; Enteroscopy; Gastrointestinal hemorrhage.

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Figures

Figure 1
Figure 1
Upper endoscopic findings in patients with suspected upper gastrointestinal bleeding. Esophageal varices (A), Dieulafoy’s lesion in the stomach (B), gastric antral vascular ectasia (watermelon stomach) in the antrum of the stomach pre and post argon plasma coagulation therapy (C, D).
Figure 2
Figure 2
Colonoscopic findings in patients with suspected lower gastrointestinal bleeding. Colonic angiodysplasia (A) and radiation proctopathy (B).
Figure 3
Figure 3
73-year-old man with per rectal bleeding and active gastrointestinal hemorrhage. Contrast enhanced computed tomography (CT) angiogram images show extravasation of contrast into the lumen of the ascending colon, with pooling of contrast which increases from the arterial phase (A, B) to the delayed venous phase (C, D). Diverticula are seen arising from the medial wall of the ascending colon indicating the etiology of bleeding. Following the CT angiogram, the patient underwent catheter angiography, which demonstrated blush of contrast from the right colic branch of the superior mesenteric artery (E). Selective catheterization of the right colic artery demonstrates the bleeding focus more clearly (F). Gelfoam and coil embolization was subsequently performed.
Figure 4
Figure 4
Jejunal angiodysplasia as seen on capsule endoscopy.
Figure 5
Figure 5
Diagnostic algorithms. A: Acute overt; B: Chronic occult; C: Obscure. CT: Computed tomography; MR: Magnetic resonance; GI: Gastrointestinal; FOBT; Fecal occult blood test.
See this image and copyright information in PMC

References

    1. Cutler JA, Mendeloff AI. Upper gastrointestinal bleeding. Nature and magnitude of the problem in the U.S. Dig Dis Sci. 1981;26:90S–96S. - PubMed
    1. Hilsden RJ, Shaffer EA. Management of gastrointestinal hemorrhage. Can Fam Physician. 1995;41:1931–1936, 1939-1941. - PMC - PubMed
    1. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997;315:510–514. - PMC - PubMed
    1. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012;307:1072–1079. - PubMed
    1. Lanas A, García-Rodríguez LA, Polo-Tomás M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, Perez-Gisbert J, Bujanda L, Castro M, Muñoz M, et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol. 2009;104:1633–1641. - PubMed