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.

Thalidomide for the Treatment of Gastrointestinal Bleeding Due to Angiodysplasia in a Patient with Glanzmann’s Thrombasthenia

“…9 The association between GI bleeding due to angiodysplasia and vWD is well recognized and described by many authors. 10-13 However, there is a paucity of data regarding the relationship of other rare bleeding disorders with GI bleeding from angiodysplasia.…”

'Bleeding Dilemma': The Story of a Periampullary Mass

“…The intermittent nature of bleeding in these conditions contributes to their obscurity. The CT angiogram (CTA), a noninvasive procedure has a sensitivity and specificity of 79%-90% and 95%-99% [ 10 - 11 ], respectively, in the detection of OGIB with a diagnostic accuracy of 100% for bleeding at a rate of 0.3-0.5 mL/min [ 12 ]. It is among the first-line diagnostic procedures that should be considered in a hemodynamically unstable obscure gastrointestinal bleed.…”

“…Commonly used embolic agents are gelatin sponges, polyvinyl alcohol (PVA) particles, acrylic microspheres, and steel coils. Surgery is indicated in a few cases where the source is known, an increasing need for transfusions is noted, or there is life-threatening bleeding from a defined origin [ 12 ].…”

Bowel Angiodysplasia and Myocardial Infarction secondary to an ischaemic imbalance: a case report

“…While overt GIB is visible (e.g. hematemesis, hematochezia or melena), obscure GIB is a persistent and recurrent bleeding in wich an upper endoscopy and colonoscopy and/or small bowel radiography cannot find the bleeding source [4]. Occult bleeding is a not visible bleeding often manifested as a positive fecal occult blood test (FOBT) or iron deficiency anemia with or without a positive FOBT.…”