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World J Gastrointest Pathophysiol. Nov 15, 2014; 5(4): 467-478
Published online Nov 15, 2014. doi: 10.4291/wjgp.v5.i4.467
Diagnosis of gastrointestinal bleeding: A practical guide for clinicians
Bong Sik Matthew Kim, Bob T Li, Alexander Engel, Jaswinder S Samra, Stephen Clarke, Ian D Norton, Angela E Li
Bong Sik Matthew Kim, Ian D Norton, Department of Gastroenterology, Royal North Shore Hospital, St Leonards NSW 2065, Sydney, Australia
Bob T Li, Stephen Clarke, Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Sydney, Australia
Alexander Engel, Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards NSW 2065, Sydney, Australia
Jaswinder S Samra, Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards NSW 2065, Sydney, Australia
Bob T Li, Alexander Engel, Jaswinder S Samra, Stephen Clarke, Ian D Norton, Sydney Medical School, University of Sydney, Camperdown NSW 2050, Sydney, Australia
Jaswinder S Samra, Angela E Li, Australian School of Advanced Medicine, Macquarie University, North Ryde NSW 2109, Sydney, Australia
Author contributions: Kim BSM and Li BT equally contributed to writing the initial manuscript; Samra JS and Norton ID contributed to the Overt (Acute) GI Bleeding section; Norton ID provided the photographic images; Li AE produced the algorithms; Engel A and Clarke S appraised the overall work; Li BT coordinated the revision of final manuscript and submitted it on behalf of co-authors; all authors contributed to the conception and design of the manuscript.
Correspondence to: Dr. Bob T Li, Department of Medical Oncology, Royal North Shore Hospital, Reserve Rd, St Leonards NSW 2065, Sydney, Australia. bob.li@med.usyd.edu.au
Telephone: +61-2-94631172 Fax: +61-2-94631092
Received: April 22, 2014
Revised: July 15, 2014
Accepted: August 27, 2014
Published online: November 15, 2014
Abstract

Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is not apparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.

Keywords: Gastrointestinal hemorrhage, Diagnostic techniques, Endoscopy, Colonoscopy, Capsule endoscopy, Enteroscopy, Computed tomography, Angiography

Core tip: This review provides a practical diagnostic guide for clinicians who encounter patients with suspected gastrointestinal bleeding in the hospital and primary health care settings. Clinical presentations of gastrointestinal bleeding are classified as overt (acute), occult (chronic) or obscure and the corresponding diagnostic algorithms are illustrated through review of the key evidence and consensus guidelines. Upper endoscopy and colonoscopy are the mainstay of initial investigations. Angiography and radionuclide imaging are best suited for acute overt gastrointestinal (GI) bleeding. Capsule endoscopy and deep enteroscopy play significant roles in the diagnosis of obscure GI bleeding, usually from the small bowel.