Diagnostic and therapeutic considerations for obscure gastrointestinal bleeding in patients with chronic kidney disease

Abstract

Recurrent obscure gastrointestinal bleeding amongst patients with chronic kidney disease is a challenging problem gastroenterologists are facing and is associated with an extensive diagnostic workup, limited therapeutic options, and high healthcare costs. Small-bowel angiodysplasia is the most common etiology of obscure and recurrent gastrointestinal bleeding in the general population. Chronic kidney disease is associated with a higher risk of gastrointestinal bleeding and of developing angiodysplasia compared with the general population. As a result, recurrent bleeding in this subgroup of patients is more prevalent and is associated with an increased number of endoscopic and radiographic procedures with uncertain benefit. Alternative medical therapies can reduce re-bleeding; however, more studies are needed to confirm their efficacy in this subgroup of patients.

Keywords: Obscure gastrointestinal bleeding; angiodysplasia; arteriovenous malformations; chronic kidney disease; small-bowel bleeding.

Figure 1

Above is a recommended diagnostic algorithm for obscure gastrointestinal bleeding in patients with chronic kidney disease. Adapted from “ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding” [8] and “Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline” [31] EGD, esophagogastroduodenoscopy; CT, computed tomography.