Obscure gastrointestinal bleeding: An approach to management

Obscure gastrointestinal bleeding provides an uncommon bur: frustrating and resource-intensive challenge for clinicians. Such patients hemorrhage recu rrently from sites within the gastrointestinal tract that are nor. detected by routine endoscopy or radiography, and require a special diagnostic appr oach to localize or exclude less common bleeding sources such as Small bowe l angioectasia or neoplasia. The differential diagnosis of obscure gastroin testinal hemorrhage is discussed, and the performance of available endoscop ic, radiological and surgical diagnostic tools including enteroscopy are ex amined critically. A stepwise management algorithm that progresses from the history and physical examination to surgical exploration is offered to fac ilitate early acid efficient diagnosis.