Investigating occult gastrointestinal haemorrhage

doi:10.1136/bmj.39577.673507.BE

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 availableto diagnose recurrent blood loss from the gastrointestinal tract

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

Learning points

Recurrent iron deficiency anaemia as a resultof occult gastrointestinal blood loss is common in elderly people

Mostcauses are within reach of conventional endoscopy (oesophagogastroduodenoscopyand colonoscopy)

Small bowel barium radiology is rarely helpfulin patients with no gastrointestinal symptoms

Capsule endoscopyis the first line investigation in patients with normal resultson oesophagogastroduodenoscopy and colonoscopy

Capsule endoscopyestablishes an accurate diagnosis in most cases, allowing treatmentto be tailored to the individual and avoiding unnecessary endoscopicor radiological investigations

The patient

A 78 year old woman with moderate renal impairment as a resultof renovascular disease presented with tiredness and malaise.Twelve years earlier she had had an inferior myocardial infarctioncomplicated by severe mitral incompetence, which was treatedby mitral valve replacement and coronary artery bypass grafting.She had been taking warfarin since this time, but she had nottaken aspirin or non-steroidal anti-inflammatory drugs. On examinationshe was . . . [Full text of this article]

What is the next investigation?

Small bowel barium studies
Radionuclide studies
Computed tomography scanning
Catheter angiography
Enteroscopy
Videocapsule endoscopy

Outcome

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