Summary
Definition
History and exam
Other diagnostic factors
- age >60 years
- shortness of breath
- fatigue
- pallor
- tachycardia
- hypotension
Risk factors
- chronic renal failure/end-stage renal disease
- von Willebrand's disease
- aortic stenosis
- scleroderma
- cardiovascular disease
- increasing age
Diagnostic investigations
1st investigations to order
- FBC
- blood type and crossmatch
- urea and electrolyte
- oesophago-gastro-duodenoscopy
- colonoscopy
Investigations to consider
- wireless capsule enteroscopy
- CT angiography
- selective mesenteric angiography
- technetium Tc-99m radionuclide scan
- CT enterography
- push enteroscopy or device-assisted enteroscopy
Treatment algorithm
Contributors
Authors
Reena Sidhu, MD, FRCP
Consultant Gastroenterologist
Royal Hallamshire Hospital
Sheffield Teaching Hospitals NHS Foundation Trust
Hon Professor
Division of Clinical Medicine
School of Medicine and Population Health
University of Sheffield
Sheffield
UK
Disclosures
RS has received speaker fees and congress travel grants (Dr Falk 2021 & 2023). RS has attended ANx Robotica symposium 2023. RS is an author of a reference cited in this topic.
Nicoletta Nandi, MD
Clinical Fellow
Academic Unit of Gastroenterology
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
Disclosures
NN declares that she has no competing interests.
Acknowledgements
Prof Reena Sidhu and Dr Nicoletta Nandi would like to gratefully acknowledge Dr Aidan Shaw, Dr Heather Lee, and Dr William Speake, previous contributors to this topic.
Disclosures
AS, HL, and WS declare that they have no competing interests.
Peer reviewers
Alessandro Fichera, MD, FACS, FASCRS
Assistant Professor
Department of Surgery
University of Chicago
Chicago
IL
Disclosures
AF declares that he has no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
DJH declares that he has no competing interests.
References
Key articles
Gerson LB, Fidler JL, Cave DR, et al. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015 Sep;110(9):1265-87; quiz 1288.Full text Abstract
Sengupta N, Kastenberg DM, Bruining DH, et al. The role of imaging for GI bleeding: ACG and SAR consensus recommendations. Radiology. 2024 Mar;310(3):e232298. Abstract
Triantafyllou K, Gkolfakis P, Gralnek IM, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2021 Aug;53(8):850-68.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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