American Gastroenterological Association (AGA) Institute Medical Position Statement on Obscure Gastrointestinal Bleeding

Raju, Gottumukkala S.; Gerson, Lauren B.; Das, Ananya; Lewis, Blair S.

doi:10.1053/j.gastro.2007.06.008

Cited by 218 publications

(146 citation statements)

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“…According to the American Gastroenterological Association (AGA) [23] , younger patients are likely to have small intestinal tumors, Meckel's diverticulum, Dieulafoy's lesion, and Crohn's disease, while older patients (older than 40 years) are prone to bleeding from vascular lesions, which comprise of up to 40% of all causes, and nonsteroidal anti-inflammatory drug-induced small bowel disease. Our finding was somewhat different from the AGA.…”

Section: Discussionmentioning

confidence: 99%

Single-center experience of 309 consecutive patients withobscure gastrointestinal bleeding

Zhang¹,

Fang²,

Chen³

et al. 2009

WJG

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AIM:To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS:Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE findings. RESULTS:Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common finding in the entire cohort, these accounted for 30% of clinically significant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleeding group, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION:In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

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Section: Discussionmentioning

confidence: 99%

Single-center experience of 309 consecutive patients withobscure gastrointestinal bleeding

Zhang¹,

Fang²,

Chen³

et al. 2009

WJG

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“…All patients included in the study underwent upper digestive endoscopy with multiple duodenal biopsy taking (4)(5)(6). Samples were routinely stained with hematoxylin-eosin (H-E) and specific immunohistochemical stains for CD3 to assess the presence of intra-epithelial lymphocytes (IELs), which were counted for every one hundred epithelial cells.…”

Section: Methodsmentioning

confidence: 99%

“…; and b) from reduced intestinal iron absorption, as occurs in celiac disease, gastric atrophy, gastrectomy, intestinal resection or bypass, etc. (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Refractory iron-deficiency anemia and gluten intolerance: Response to gluten-free diet

et al. 2011

Rev. esp. enferm. dig.

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Introduction: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common.Objectives: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients.Methods: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response.Results: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes.Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects.Conclusions: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development.

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“…A family history of cancer occurring at an early age, particularly colorectal or endometrial, may suggest the presence of hereditary nonpolyposis colorectal cancer. Their relative frequency has not been well defined in large trials but probably depends upon age [8] . (5) No source found.…”

Section: Ethiologymentioning

confidence: 99%

Occult and obscure gastrointestinal bleeding: Causes and diagnostic approach in 2009

Bresci¹

2009

WJGE

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Gastrointestinal bleeding can be obscure or occult (OGIB), the causes and diagnostic approach will be discussed in this editorial. The evaluation of OGIB consists on a judicious search of the cause of bleeding, which should be guided by the clinical history and physical findings. The standard approach to patients with OGIB is to directly evaluate the gastrointestinal tract by endoscopy, abdominal computed tomography, angiography, radionuclide scanning, capsule endoscopy. The source of OGIB can be identified in 85%-90%, no bleeding sites will be found in about 5%-10% of cases. Even if the bleedings originating from the small bowel are not frequent in clinical practice (7.6% of all digestive haemorrhages, in our casuistry), they are notoriously difficult to diagnose. In spite of progress, however, a number of OGIB still remain problematic to deal with at present in the clinical context due to both the difficulty in exactly identifying the site and nature of the underlying source and the difficulty in applying affective and durable diagnostic approaches so no single technique has emerged as the most efficient way to evaluate OGIB.

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American Gastroenterological Association (AGA) Institute Medical Position Statement on Obscure Gastrointestinal Bleeding

Cited by 218 publications

References 1 publication

Single-center experience of 309 consecutive patients withobscure gastrointestinal bleeding

Single-center experience of 309 consecutive patients withobscure gastrointestinal bleeding

Refractory iron-deficiency anemia and gluten intolerance: Response to gluten-free diet

Occult and obscure gastrointestinal bleeding: Causes and diagnostic approach in 2009

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