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World J Gastrointest Pathophysiol. Aug 15, 2014; 5(3): 271-283
Published online Aug 15, 2014. doi: 10.4291/wjgp.v5.i3.271
New insights to occult gastrointestinal bleeding: From pathophysiology to therapeutics
Antonio Damián Sánchez-Capilla, Paloma De La Torre-Rubio, Eduardo Redondo-Cerezo
Antonio Damián Sánchez-Capilla, Paloma De La Torre-Rubio, Department of Gastroenterology, University Hospital Virgen de, Las Nieves, 18014 Granada, Spain
Eduardo Redondo-Cerezo, Endoscopy Unit, Department of Gastroenterology, University Hospital Virgen de Las Nieves, 18014 Granada, Spain
Author contributions: Sánchez-Capilla AD and De La Torre-Rubio P reviewed the bibliography and wrote the first draft; Redondo-Cerezo E overviewed the paper and wrote the final paper in English.
Correspondence to: Eduardo Redondo-Cerezo, MD, PhD, Endoscopy Unit, Department of Gastroenterology, University Hospital Virgen de Las Nieves, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain.
Telephone: +34-958-020146 Fax: +34-958-120169
Received: March 11, 2014
Revised: June 1, 2014
Accepted: June 18, 2014
Published online: August 15, 2014

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.

Keywords: Obscure gastrointestinal bleeding, Angiodysplasia, Wireless capsule endoscopy, Double balloon enteroscopy

Core tip: This is an invited in depth review of occult gastrointestinal bleeding, addressing its pathophysiology, diagnosis and treatment. Our paper tries to unify in one single manuscript all what a general gastroenterologist should know about those items. From the essentials of pathophysiology, we have tried to build a rational approach to those patients’ management depending on the severity of the condition, proposing an evidence-based management algorithm.