ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Lauren B. Gerson, MD, MSc, FACG; Jeff L. Fidler, MD; David R. Cave, MD, PhD, FACG; Jonathan A. Leighton, MD, FACG


Am J Gastroenterol. 2015;110(9):1265-1287. 

In This Article


The occurrence of small bowel bleeding remains a relatively uncommon event. A significant percentage of patients with suspected small bowel bleeding will have sources of bleeding detected upon repeat upper and lower endoscopic examinations. The remainder of the patients will likely demonstrate sources of bleeding in the small bowel on VCE, deep enteroscopy or CTE studies. Given the efficacy of these new imaging modalities, the prior classification of "obscure GI bleeding" should be reserved for patients in whom a bleeding source cannot be demonstrated after an extensive evaluation. Small bowel angiodysplastic lesions remain the most common cause of small bowel bleeding, and despite endoscopic therapy, demonstrate high recurrence rates. Medical therapy with somatostatin analogs or antiangiogenic agents may be an option for refractory patients. Surgical therapy should be reserved for patients requiring lysis of adhesions for successful deep enteroscopy, and aortic valve replacement should be considered for patients with Heyde's syndrome.