Gastrointestinal bleeding of obscure origin

Unexplained gastrointestinal (GI) bleeding is a frustrating problem for both patient and gastroenterologist. The true incidence of obscure occult bleeding is unknown but can be as great as 20%. Perhaps more important, the length of time patients experience obscure bleeding, both overt and occult, and the long-term outcomes are also not known. Even when experiencing unrelenting bleeding, many patients do not die of this condition or its related complications. These patients incur significant health care costs, and their evaluation should maximize the potential for a diagnosis and a clear treatment strategy. The key observations that facilitate arriving at a diagnosis are: (1) patient age; (2) overt versus occult bleeding; (3) extraintestinal symptoms and physical findings; (4) medication use; (5) prior history of malignancy, abdominal and pelvic radiation therapy, and Crohn's disease; and (6) prior endoscopic and radiologic studies.