There are a number of common gastrointestinal conditions, disorders and diseases that may cause problems. These include:
Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract that persists or recurs without an obvious cause after gastroscopy, colonoscopy and radiologic evaluation of the small bowel. OGIB is a Obscure bleeding is subdivided into:
(i) Overt bleeding which is bright or dark red bleeding or black stool (also known as melaena)
(ii) Occult (positive faecal occult blood test (FOBT) and/or iron-deficiency anaemia when there is no evidence of visible blood loss)
There are many causes for OGIB including Cameron's erosions, fundic varices, peptic ulcer, gastric antral vascular ectasia (GAVE), haemobilia, angioectasias, Dieulafoy's lesion, neoplasms/tumours, Meckel's diverticulum, Crohn's disease, coeliac disease and NSAID induced enteropathy.
Investigations for OGIB may include blood tests, gastroscopy, capsule endoscopy, double balloon enteroscopy, colonoscopy, CT enterography, CT angiography, mesenteric angiography and/or embolisation and red cell scan. For difficult cases, often some of these tests need to be repeated, ideally when bleeding is actively occurring to increase the chance of detecting the location of the bleeding point. Accurate localisation of bleeding is usually the most challenging aspect to this problem, treatment afterwards tends to be more straightforward!
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