Evaluation Management of Obscure Gastrointestinal Bleeding (OGIB)

Gastrointestinal bleeding is a common entity. Incidence of bleeding has comparatively increased though case fatality is static. Despite improved treatments and better understanding of the underlying pathophysiology of peptic ulcer disease the rising figures of GI bleeding reflect an increasing proportion of elderly population and nonsteroidal anti-inflammatory use. Overall, 5% of all cases of gastrointestinal bleeding fall under the category of Obscure gastrointestinal bleeding (OGIB) in the USA. Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after an initial negative endoscopic evaluation including colonoscopy and/or upper endoscopy. OGIB can be either Occult (no visible blood) or Overt (Passage of visible blood). Less common aetiologies of GI bleeding e.g. Cameron erosions, Dieulafoy’s lesion, Watermelon stomach that are sometimes difficult to identify at endoscopy often present as OGIB. They need special techniques even thrombolytic therapy to precipitate bleeding for diagnostic angiography. Increased awareness of the existence of such conditions help in rapid and accurate identification of the lesion. Review of such cases will be the focus of this publication.