Published online Nov 15, 2014. doi: 10.4291/wjgp.v5.i4.467
Revised: July 15, 2014
Accepted: August 27, 2014
Published online: November 15, 2014
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.
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.