Published 3 July 2008, doi:10.1136/bmj.39577.673507.BE
Cite this as: BMJ 2008;337:a422

Practice

Rational Imaging

Investigating occult gastrointestinal haemorrhage

H R Dalton, consultant gastroenterologist , G F Maskell, consultant radiologist

1 Royal Cornwall Hospital, Truro TR1 3LJ

Correspondence to: H R Dalton harry.dalton@rcht.cornwall.nhs.uk

This article explores the radiological investigations available to diagnose recurrent blood loss from the gastrointestinal tract

The first 150 words of the full text of this article appear below.


Recurrent iron deficiency anaemia as a result of occult gastrointestinal blood loss is common in elderly people
Most causes are within reach of conventional endoscopy (oesophagogastroduodenoscopy and colonoscopy)
Small bowel barium radiology is rarely helpful in patients with no gastrointestinal symptoms
Capsule endoscopy is the first line investigation in patients with normal results on oesophagogastroduodenoscopy and colonoscopy
Capsule endoscopy establishes an accurate diagnosis in most cases, allowing treatment to be tailored to the individual and avoiding unnecessary endoscopic or radiological investigations


A 78 year old woman with moderate renal impairment as a result of renovascular disease presented with tiredness and malaise. Twelve years earlier she had had an inferior myocardial infarction complicated by severe mitral incompetence, which was treated by mitral valve replacement and coronary artery bypass grafting. She had been taking warfarin since this time, but she had not taken aspirin or non-steroidal anti-inflammatory drugs. On examination she was . . . [Full text of this article]


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