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  • Review Article
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Occult and obscure gastrointestinal bleeding: causes and clinical management

Nature Reviews Gastroenterology & Hepatology volume 7, pages 265–279 (2010)Cite this article

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Abstract

Occult gastrointestinal bleeding, defined as bleeding that is unknown to the patient, is the most common form of gastrointestinal bleeding and can be caused by virtually any lesion in the gastrointestinal tract. Patients with occult gastrointestinal bleeding include those with fecal occult blood and iron-deficiency anemia (IDA). In men and postmenopausal women, IDA should be considered to be the result of gastrointestinal bleeding until proven otherwise. Indeed, the possibility of gastrointestinal tract malignancy in these patients means that gastrointestinal evaluation is nearly always indicated. Obscure gastrointestinal bleeding is defined as obvious bleeding from a difficult to identify source and is always recurrent. This form of bleeding accounts for approximately 5% of all cases of clinically evident gastrointestinal bleeding and is most commonly caused by bleeding from the small intestine. Capsule endoscopy and deep enteroscopy have had a major impact on the way that patients with occult and, in particular, obscure bleeding are managed. In this Review the causes, diagnostic evaluation and treatment of occult and obscure gastrointestinal bleeding are discussed.

Key Points

  • Occult gastrointestinal bleeding (defined as bleeding that is unknown to the patient) manifests as fecal occult blood and/or iron-deficiency anemia (IDA); it is extremely common and can be caused by virtually any lesion in the gastrointestinal tract

  • IDA should be considered to be the result of gastrointestinal bleeding in men and postmenopausal women, and gastrointestinal evaluation is therefore required in this setting

  • Obscure gastrointestinal bleeding (obvious bleeding from a difficult to identify source), which is recurrent by definition, is usually caused by bleeding from the small intestine and accounts for approximately 5% of all cases of gastrointestinal bleeding

  • Capsule endoscopy and deep enteroscopy have had a major impact on the management of patients with occult and, in particular, obscure gastrointestinal bleeding

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Figure 1: Sites of gastrointestinal bleeding, intraluminal metabolism of hemoglobin and detection of intraluminal blood by fecal occult blood (FOB) tests.
Figure 2: Daily gastrointestinal blood loss and iron balance.
Figure 3: Suggested algorithm for the management of occult bleeding identified by the presence of IDA and/or fecal occult blood (FOB).
Figure 4: Suggested algorithm for the management of obscure gastrointestinal bleeding.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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    Don C. Rockey

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Rockey, D. Occult and obscure gastrointestinal bleeding: causes and clinical management. Nat Rev Gastroenterol Hepatol 7, 265–279 (2010). https://doi.org/10.1038/nrgastro.2010.42

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