Clinical Characteristics, Etiology And Pathogenesis Of Obscure Gastrointestinal Bleeding: A Single Center Analysis

Objective: Gastrointestinal bleeding is very common, and the pathogen in mostpatients could be confirmed through the upper and low endoscopic examination.However，the causes of many recurrent gastrointestinal bleeding are still not veryclear. The aim of this study was to investigate the clinical characteristics, etiology andpathogenesis of obscure gastrointestinal bleeding (OGIB) in a single center, whichmay be beneficial to increase the diagnosis yield of OGIB and improve the prognosis.Methods: From January2008to December2013,90patients with obscuregastrointestinal bleeding were enrolled in this study. The patients who were met thediagnose criteria of recommended process of diagnosis and treatment of obscuregastrointestinal bleeding(March,2012,<Revised manuscript>),and treated in theZhongshan Hospital affiliated to Xiamen University. We summarized the clinicalfeatures, etiological agent and pathogenesis mechanism of the obscure gastrointestinalbleeding.Results: Among90patients,56were male, accounting for62,2%and34were female,accounting for37.8%. Patients’ age ranged from16to82years old, while the averagewas48.5years old. Small intestinal vascular malformation won the first place with atotal of14cases.8cases were small intestinal space-occupying lesions,6of whichwere small intestinal stromal tumor and the others was diffuse large B lymphoma andmoderately differentiated adenocarcinoma separately.5cases were intestinaldiverticulum.3cases showed characteristic endoscopic performance of Crohn’sdisease by capsule endoscopy or enteroscopy without caseating granuloma inpathological biopsy.1case was Dieulafoy’s disease.1case was small intestineancylostomiasis.1case was the necrosis of the head of pancreas and bleeding of thepot of ampullar region.1case was Metastatic small intestine cancer transfer fromchoriocarcinoma.3cases were multiple ulcer of small intestine.1case was multiple erosion of ileum.1case was bleeding of duodenal bile anastomosis.30cases failed toclear etiology for patients refusing to complete the examination. And20of the totalended up with reason-obscured after the routine diagnose tests like capsule endoscopyor enteroscopy, most of which had good prognosis.Conclusion: Recent years, primary cause of obscure gastrointestinal bleeding wasintestinal vascular malformation, followed by small intestinal tumor, small intestinediverticulum, and intestinal inflammatory bowel disease, which was consistent withthe results of epidemiological studies. When the diagnose is not clear, we shouldrepeat gastroscope or colonoscopy, further lines of capsule endoscopy, double balloonenteroscopy, nuclide scan, small intestine of X line barium imaging and selectiveangiography. It is necessary to undergo endoscopic examination during operation orintraoperative dissection when it had the surgical indication.