Obscure Gastrointestinal Bleeding -- The Role of Endoscopy

Suryakanth R. Gurudu, MD; Jonathan A. Leighton, MD


May 11, 2006

In This Article


Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of unknown origin that persists or recurs after an initial negative endoscopic evaluation including colonoscopy and/or upper endoscopy (esophagogastroduodenoscopy [EGD]).[1] OGIB can be classified as either: (1) occult OGIB, which is manifested by recurrent iron deficiency anemia and/or recurrent positive fecal occult blood test (FOBT) results; or (2) overt OGIB, which is manifested as melena or hematochezia.

Angioectasias of the small bowel are the most common source of OGIB in the elderly and account for 30% to 40% of gastrointestinal bleeding in this population,[2] whereas tumors such as leiomyomas, carcinoids, lymphomas, and adenocarcinomas are the predominant cause in patients aged 30 to 50 years.[3] Meckel's diverticulum is also a potential cause of bleeding and should be considered in the differential diagnosis.[4] Erosions and ulcers from nonsteroidal anti-inflammatory drug (NSAID) use[5] and Crohn's disease of small bowel are also potential causes of OGIB. Overall, OGIB accounts for 5% of all cases of gastrointestinal hemorrhage.[6]

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