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Management of patients with occult gastrointestinal bleeding

Year 2021, Volume: 38 Issue: 2s, 38 - 43, 18.03.2021

Abstract

The majority of cases of occult bleeding are found in the course of colorectal cancer screening or during the evaluation of iron deficiency anemia. In up to half of all patients with occult GI bleeding, the source will not be found on initial endoscopic evaluation. Occult gastrointestinal bleeding is an issue with difficulties in diagnosis and treatment. It may come to the clinic as asymptomatic, detected in routine screenings or as iron deficiency of unknown etiology. In recent years, there have been great advances in the diagnosis and treatment. Capsule endoscopy and enteroscopy have provided these advances. However, the problem is not fully resolved. Additional developments are needed in this regard. In this review, the management of patients with occult gastrointestinal bleeding is explained in the light of the latest literature findings.

References

  • 1. Arakawa, D., Ohmiya, N., Nakamura, M., Honda, W., Shirai, O., Itoh, A., et al., 2009. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc. 69:866–74. doi: 10.1016/j.gie.2008. 06.008).
  • 2. Bini, E.J., Micale, P.L., Weinshel, E.H., 1998. Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia. Am J Med; 105:281.
  • 3. Bull-Henry, K., Al-Kawas, F.H., 2013. Evaluation of occult gastrointestinal bleeding. Am Fam Physician; 87:430.
  • 4. Crash-2 Collaborators, 2011. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 377:1096–101. doi: 10.1016/S0140-6736(11)60278-X).
  • 5. Doubeni, C., 2020. Tests for screening for colorectal cancer. UpToDate, Version 18.
  • 6. Duffy, M.J., van Rossum, L.G., van Turenhout, S.T., et al., 2011. Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper. Int J Cancer; 128:3.
  • 7. Ge, Z.Z., Chen, H.M., Gao, Y.J., Liu, W.Z., Xu, C.H., Tan, H.H., et al., 2011. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology. 141:1629–37.
  • 8. Ghassemi, K.A., Jensen, D.M., Jutabha, R., 2012. Gastrointestinal causes of anemia and occult bleeding. In, Hawkey CJ, Bosch J, Richter J, Garcia-Tsao G, Chan F, eds. Textbook of Clinical Gastroenterology and Hepatology, 2nd ed, Wiley-Blackwell UK., p73-77.
  • 9. Guerrouij, M., Uppal, C.S., Alklabi, A., Douketis, J.D., 2011. The clinical impact of bleeding during oral anticoagulant therapy. J Thromb Thromb. 31:419–23. doi: 10.1007/s11239-010-0536-7.
  • 10. Huang, Y., Li, Q., Ge, W., et al., 2014. Predictive power of quantitative and qualitative fecal immunochemical tests for hemoglobin in population screening for colorectal neoplasm. Eur J Cancer Prev. 23:27.
  • 11. Jackson, C.S., Gerson, L.B., 2014. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol. 109:474. doi: 10.1038/ajg.2014.19.
  • 12. Jaffe, R.M., Kasten, B., Young, D.S., MacLowry, J.D., 1975. False-negative stool occult blood tests caused by ingestion of ascorbic acid (vitamin C). Ann Intern Med. 83:824.
  • 13. Koh, S.J., Im, J.P., Kim, J.W., Kim, B.G., Lee, K.L., Kim, S.G., et al., 2013. Longterm outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastroenterol. 19:1632. doi: 10.3748/wjg.v19.i10.1632
  • 14. Levin, B., Lieberman, D.A., McFarland, B., et al., 2008. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 58:130.
  • 15. Murphy, B., Winter, D.C., Kavanagh, D.O., 2019. Small Bowel Gastrointestinal Bleeding Diagnosis and Management—A Narrative Review. Front. Surg. 6:25. doi: 10.3389/fsurg.2019.00025.
  • 16. Park, M.J., Choi, K.S., Lee, Y.K., et al., 2012. A comparison of qualitative and quantitative fecal immunochemical tests in the Korean national colorectal cancer screening program. Scand J Gastroenterol. 47:461.
  • 17. Patel, T.H., Cordts, P.R., Abcarian, P., Sawyer, M.A., 2001. Will transcatheter embolotherapy replace surgery in the treatment of gastrointestinal bleeding? 22. Curr Surg. 58:323–7. doi: 10.1016/S0149-7944(01)00417-2.
  • 18. Perencevich, M., Saltzman, J.R., 2020. Evaluation of occult gastrointestinal bleeding. UpToDate, Version 18.
  • 19. Pignone, M., Campbell, M.K., Carr, C., Phillips, C.. 2001. Meta-analysis of dietary restriction during fecal occult blood testing. Eff Clin Pract. 4:150.
  • 20. Raju, G.S., Gerson, L., Das, A., et al., 2007. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology. 133:1694.
  • 21. Roberts, I., Perel, P., Prieto-Merino, D., Shakur, H., Coats, T., Hunt, B.J., et al., 2012. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial. BMJ. 345:e5839. doi: 10.1136/bmj.e5839.
  • 22. Robertson, D.J., Lee, J.K., Boland, C.R., et al., 2017. Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 152:1217.
  • 23. Rockey, D.C., 2010. Occult and obscure gastrointestinal bleeding: causes and clinical management. Nat Rev Gastroenterol Hepatol. 7:265.
  • 24. Sawhney, M.S., McDougall, H., Nelson, D.B., Bond, J.H., 2010. Fecal occult blood test in patients on low-dose aspirin, warfarin, clopidogrel, or non-steroidal anti-inflammatory drugs. Dig Dis Sci. 55:1637.
  • 25. Schenker, M.P., Duszak, R. Jr., Soulen, M.C., Smith, K.P., Baum, R.A., Cope, C., et al., 2001. Shlansky-goldberg. upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Int Radiol. 12:1263–71. doi: 10.1016.
  • 26. Vlachogiannakos, J., Papaxoinis, K., Viazis, N., et al., 2011. Bleeding lesions within reach of conventional endoscopy in capsule endoscopy examinations for obscure gastrointestinal bleeding: is repeating endoscopy economically feasible? Dig Dis Sci. 56:1763.
  • 27. Wong, M.C., Ching, J.Y., Chan, V.C., et al., 2015. Diagnostic Accuracy of a Qualitative Fecal Immunochemical Test Varies With Location of Neoplasia But Not Number of Specimens. Clin Gastroenterol Hepatol. 13:1472.
  • 28. Young, G.P., Symonds, E.L., Allison, J.E., et al., 2015. Advances in Fecal Occult Blood Tests: the FIT revolution. Dig Dis Sci. 60:609.
Year 2021, Volume: 38 Issue: 2s, 38 - 43, 18.03.2021

Abstract

References

  • 1. Arakawa, D., Ohmiya, N., Nakamura, M., Honda, W., Shirai, O., Itoh, A., et al., 2009. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc. 69:866–74. doi: 10.1016/j.gie.2008. 06.008).
  • 2. Bini, E.J., Micale, P.L., Weinshel, E.H., 1998. Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia. Am J Med; 105:281.
  • 3. Bull-Henry, K., Al-Kawas, F.H., 2013. Evaluation of occult gastrointestinal bleeding. Am Fam Physician; 87:430.
  • 4. Crash-2 Collaborators, 2011. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 377:1096–101. doi: 10.1016/S0140-6736(11)60278-X).
  • 5. Doubeni, C., 2020. Tests for screening for colorectal cancer. UpToDate, Version 18.
  • 6. Duffy, M.J., van Rossum, L.G., van Turenhout, S.T., et al., 2011. Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper. Int J Cancer; 128:3.
  • 7. Ge, Z.Z., Chen, H.M., Gao, Y.J., Liu, W.Z., Xu, C.H., Tan, H.H., et al., 2011. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology. 141:1629–37.
  • 8. Ghassemi, K.A., Jensen, D.M., Jutabha, R., 2012. Gastrointestinal causes of anemia and occult bleeding. In, Hawkey CJ, Bosch J, Richter J, Garcia-Tsao G, Chan F, eds. Textbook of Clinical Gastroenterology and Hepatology, 2nd ed, Wiley-Blackwell UK., p73-77.
  • 9. Guerrouij, M., Uppal, C.S., Alklabi, A., Douketis, J.D., 2011. The clinical impact of bleeding during oral anticoagulant therapy. J Thromb Thromb. 31:419–23. doi: 10.1007/s11239-010-0536-7.
  • 10. Huang, Y., Li, Q., Ge, W., et al., 2014. Predictive power of quantitative and qualitative fecal immunochemical tests for hemoglobin in population screening for colorectal neoplasm. Eur J Cancer Prev. 23:27.
  • 11. Jackson, C.S., Gerson, L.B., 2014. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol. 109:474. doi: 10.1038/ajg.2014.19.
  • 12. Jaffe, R.M., Kasten, B., Young, D.S., MacLowry, J.D., 1975. False-negative stool occult blood tests caused by ingestion of ascorbic acid (vitamin C). Ann Intern Med. 83:824.
  • 13. Koh, S.J., Im, J.P., Kim, J.W., Kim, B.G., Lee, K.L., Kim, S.G., et al., 2013. Longterm outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastroenterol. 19:1632. doi: 10.3748/wjg.v19.i10.1632
  • 14. Levin, B., Lieberman, D.A., McFarland, B., et al., 2008. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 58:130.
  • 15. Murphy, B., Winter, D.C., Kavanagh, D.O., 2019. Small Bowel Gastrointestinal Bleeding Diagnosis and Management—A Narrative Review. Front. Surg. 6:25. doi: 10.3389/fsurg.2019.00025.
  • 16. Park, M.J., Choi, K.S., Lee, Y.K., et al., 2012. A comparison of qualitative and quantitative fecal immunochemical tests in the Korean national colorectal cancer screening program. Scand J Gastroenterol. 47:461.
  • 17. Patel, T.H., Cordts, P.R., Abcarian, P., Sawyer, M.A., 2001. Will transcatheter embolotherapy replace surgery in the treatment of gastrointestinal bleeding? 22. Curr Surg. 58:323–7. doi: 10.1016/S0149-7944(01)00417-2.
  • 18. Perencevich, M., Saltzman, J.R., 2020. Evaluation of occult gastrointestinal bleeding. UpToDate, Version 18.
  • 19. Pignone, M., Campbell, M.K., Carr, C., Phillips, C.. 2001. Meta-analysis of dietary restriction during fecal occult blood testing. Eff Clin Pract. 4:150.
  • 20. Raju, G.S., Gerson, L., Das, A., et al., 2007. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology. 133:1694.
  • 21. Roberts, I., Perel, P., Prieto-Merino, D., Shakur, H., Coats, T., Hunt, B.J., et al., 2012. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial. BMJ. 345:e5839. doi: 10.1136/bmj.e5839.
  • 22. Robertson, D.J., Lee, J.K., Boland, C.R., et al., 2017. Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 152:1217.
  • 23. Rockey, D.C., 2010. Occult and obscure gastrointestinal bleeding: causes and clinical management. Nat Rev Gastroenterol Hepatol. 7:265.
  • 24. Sawhney, M.S., McDougall, H., Nelson, D.B., Bond, J.H., 2010. Fecal occult blood test in patients on low-dose aspirin, warfarin, clopidogrel, or non-steroidal anti-inflammatory drugs. Dig Dis Sci. 55:1637.
  • 25. Schenker, M.P., Duszak, R. Jr., Soulen, M.C., Smith, K.P., Baum, R.A., Cope, C., et al., 2001. Shlansky-goldberg. upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Int Radiol. 12:1263–71. doi: 10.1016.
  • 26. Vlachogiannakos, J., Papaxoinis, K., Viazis, N., et al., 2011. Bleeding lesions within reach of conventional endoscopy in capsule endoscopy examinations for obscure gastrointestinal bleeding: is repeating endoscopy economically feasible? Dig Dis Sci. 56:1763.
  • 27. Wong, M.C., Ching, J.Y., Chan, V.C., et al., 2015. Diagnostic Accuracy of a Qualitative Fecal Immunochemical Test Varies With Location of Neoplasia But Not Number of Specimens. Clin Gastroenterol Hepatol. 13:1472.
  • 28. Young, G.P., Symonds, E.L., Allison, J.E., et al., 2015. Advances in Fecal Occult Blood Tests: the FIT revolution. Dig Dis Sci. 60:609.
There are 28 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Clinical Research
Authors

Ahmet Bektaş 0000-0001-7026-9353

Publication Date March 18, 2021
Submission Date September 13, 2020
Acceptance Date October 30, 2020
Published in Issue Year 2021 Volume: 38 Issue: 2s

Cite

APA Bektaş, A. (2021). Management of patients with occult gastrointestinal bleeding. Journal of Experimental and Clinical Medicine, 38(2s), 38-43.
AMA Bektaş A. Management of patients with occult gastrointestinal bleeding. J. Exp. Clin. Med. March 2021;38(2s):38-43.
Chicago Bektaş, Ahmet. “Management of Patients With Occult Gastrointestinal Bleeding”. Journal of Experimental and Clinical Medicine 38, no. 2s (March 2021): 38-43.
EndNote Bektaş A (March 1, 2021) Management of patients with occult gastrointestinal bleeding. Journal of Experimental and Clinical Medicine 38 2s 38–43.
IEEE A. Bektaş, “Management of patients with occult gastrointestinal bleeding”, J. Exp. Clin. Med., vol. 38, no. 2s, pp. 38–43, 2021.
ISNAD Bektaş, Ahmet. “Management of Patients With Occult Gastrointestinal Bleeding”. Journal of Experimental and Clinical Medicine 38/2s (March 2021), 38-43.
JAMA Bektaş A. Management of patients with occult gastrointestinal bleeding. J. Exp. Clin. Med. 2021;38:38–43.
MLA Bektaş, Ahmet. “Management of Patients With Occult Gastrointestinal Bleeding”. Journal of Experimental and Clinical Medicine, vol. 38, no. 2s, 2021, pp. 38-43.
Vancouver Bektaş A. Management of patients with occult gastrointestinal bleeding. J. Exp. Clin. Med. 2021;38(2s):38-43.