Gastroenterology

Gastroenterology

Volume 133, Issue 5, November 2007, Pages 1694-1696
Gastroenterology

AGA Institute
American Gastroenterological Association (AGA) Institute Medical Position Statement on Obscure Gastrointestinal Bleeding

https://doi.org/10.1053/j.gastro.2007.06.008Get rights and content

This document presents the official recommendations of the American Gastroenterological Association (AGA) Institute on “Evaluation and Management of Occult and Obscure Gastrointestinal Bleeding.” It was approved by the Clinical Practice and Economics Committee on March 12, 2007, and by the AGA Institute Governing Board on May 19, 2007.

This medical position statement is based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature.1

Section snippets

Etiology and Definitions

Obscure GI bleeding, defined as bleeding from the GI tract that persists or recurs without an obvious etiology after esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic evaluation of the small bowel such as small bowel follow-through or enteroclysis, could be categorized into obscure overt and obscure occult bleeding based on the presence or absence of clinically evident bleeding.

Bleeding lesions that are overlooked in the esophagus, stomach, and colon during initial workup or lesions

Evaluation and Management

The 2000 position statement of the American Gastroenterological Association proposed progressive testing with bleeding scans and angiography for those patients with active bleeding and repeat endoscopy, enteroscopy, enteroclysis, or small bowel series for those not actively bleeding. With continued blood loss, intraoperative enteroscopy was suggested. Due to lack of definitive diagnostic modalities before 2000, the management costs included at least $33,630 per patient without a diagnosis made.

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The Medical Position Statements (MPS) developed under the aegis of the AGA Institute and its Clinical Practice and Economics Committee (CPEC) were approved by the AGA Institute Governing Board. The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients, with the intent of suggesting preferred approaches to specific medical issues or problems. They are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature. Ideally, the intent is to provide evidence based upon prospective, randomized placebo-controlled trials; however, when this is not possible the use of experts’ consensus may occur. The recommendations are intended to apply to healthcare providers of all specialties. It is important to stress that these recommendations should not be construed as a standard of care. The AGA Institute stresses that the final decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient’s current medical situation.

Address requests for reprints to: Chair, Clinical Practice and Economics Committee, AGA National Office, c/o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. Fax: (301) 654-5920.

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