2,157 results match your criteria bleeding obscure

Risk of Rebleeding in Patients with Small Bowel Vascular Lesions.

Intern Med 2021 Jun 12. Epub 2021 Jun 12.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan.

Background With recent advances in endoscopic modalities, small bowel vascular lesions (SBVLs) are often now detected in patients with gastrointestinal bleeding. Given the high invasiveness of endoscopic treatment, it is important to select patients at high risk for bleeding. Aim To assess the risk of rebleeding in patients with SBVLs as a systemic disease rather than a gastrointestinal disease in relation to their general health. Read More

View Article and Full-Text PDF

Timing of enteroscopy in overt-obscure gastrointestinal bleeding - a systematic review and meta-analysis.

Rev Esp Enferm Dig 2021 Jun 1. Epub 2021 Jun 1.

Gastrenterology, Centro Hospitalar Vila Nova de Gaia/Espinho.

Background: The impact of early enteroscopy in the outcome of overt-obscure gastrointestinal bleeding (OGIB) is still not clear. Our aim is to evaluate the impact of early enteroscopy in overt-OGIB.

Methods: Pubmed/(MEDLINE), Web of Science and Scopus were systematically reviewed. Read More

View Article and Full-Text PDF

Bowel Arteriovenous Malformation: An Unusual Cause of Lower Gastrointestinal Bleeding in a Child.

GE Port J Gastroenterol 2021 Apr 18;28(3):207-209. Epub 2020 Sep 18.

Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

In a child, lower gastrointestinal tract bleeding can be attributed to different etiologies. Unusually, the presence of bowel arteriovenous malformations can lead to multiple bouts of painless bright red bleeding per rectum, which develop into severe anemia. The article focuses on the diagnosis and management of bowel arteriovenous malformation in a child. Read More

View Article and Full-Text PDF

Capsule enteroscopy versus scintigraphy for the diagnosis of obscure gastrointestinal bleeding.

Rev Esp Enferm Dig 2021 May 21. Epub 2021 May 21.

Gastroenterology, Centro Hospitalar Universitário de São João.

Background: Capsule enteroscopy (CE) and 99mTc Red blood cell (RBC) scintigraphy are frequently used tests in the investigation of obscure gastrointestinal bleeding (OGIB). There is a scarcity of data comparing both diagnostic modalities. This study aims to assess the performance of CE and scintigraphy for the diagnosis of OGIB. Read More

View Article and Full-Text PDF

Unexplained anemia: A case report of metachronous adenocarcinoma arising in the transverse colon following right hemicolectomy for a primary cecal carcinoma.

Qatar Med J 2021 30;2021(1):16. Epub 2021 Apr 30.

Department of Surgery, FMH College of Medicine & Dentistry, Lahore, Pakistan E-mail:

Metachronous colonic carcinomas arise from months to years after the resection of the first or index primary colorectal cancer. They are not a result of tumor recurrence or metastasis and likely arise as a result of the field cancerization effect. This report presents the case of a 63-year-old male patient without family history of a colorectal cancer but had an index primary adenocarcinoma of the cecum (stage IIIC) five years ago that was treated with surgical resection and adjuvant radiotherapy and chemotherapy. Read More

View Article and Full-Text PDF

Cancer-Related Venous Thromboembolism: From Pathogenesis to Risk Assessment.

Semin Thromb Hemost 2021 May 14. Epub 2021 May 14.

Department of Medical Oncology, Centro Hospitalar Universitário do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.

Cancer-related venous thromboembolism (VTE) remains a major health problem, accounting for at least 18% of all cases of VTE. Cancer patients with VTE have worse prognosis than those without VTE. Prophylaxis reduces VTE risk, but it is not feasible for all outpatients with cancer due to an increased bleeding risk. Read More

View Article and Full-Text PDF

ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding: 2021 Update.

J Am Coll Radiol 2021 May;18(5S):S139-S152

Specialty Chair, University of Chicago Hospital, Chicago, Illinois.

Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Read More

View Article and Full-Text PDF

Clinical Outcomes between P1 and P0 Lesions for Obscure Gastrointestinal Bleeding with Negative Computed Tomography and Capsule Endoscopy.

Diagnostics (Basel) 2021 Apr 6;11(4). Epub 2021 Apr 6.

Department of biostatistics, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea.

Background: A simple classification for the relevance of lesions (P0, P1, and P2; no bleeding potential, less likely to bleed, and more likely to bleed, respectively) based on capsule endoscopy (CE) findings has been used. This study aimed at investigating rebleeding rates and predictive factors of P0 and P1 lesions after obtaining negative findings in both, CE and computed tomography (CT), for patients with obscure gastrointestinal bleeding (OGIB).

Methods: Among 193 patients resulted in negative CE findings defined as P0 or P1 lesions, 84 patients with negative results on CT images were enrolled in this study. Read More

View Article and Full-Text PDF

Endoscopic spectrum and practical classification of small bowel gastrointestinal stromal tumors (GISTs) detected during double-balloon enteroscopy.

Endosc Int Open 2021 Apr 17;9(4):E507-E512. Epub 2021 Mar 17.

Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, Alabama, United States.

Information about the endoscopic characterization of small bowel gastrointestinal tumors (GISTs) is limited. The aim of this case study was to describe the endoscopic spectrum of small bowel GISTs and to present a practical classification. Observational, retrospective, consecutive case series of patients with small bowel GIST. Read More

View Article and Full-Text PDF

A randomized controlled trial of high volume simethicone to improve visualization during capsule endoscopy.

PLoS One 2021 1;16(4):e0249490. Epub 2021 Apr 1.

Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.

Background: The optimal dose of simethicone before capsule endoscopy is unknown. Prior studies have reported inconsistent cleansing, with some showing improved visualization only in the proximal small intestine. We hypothesized a higher volume of simethicone may improve cleansing and diagnostic yield, especially in the distal small bowel. Read More

View Article and Full-Text PDF

Clinical Performance of New Software to Automatically Detect Angioectasias in Small Bowel Capsule Endoscopy.

GE Port J Gastroenterol 2021 Feb 20;28(2):87-96. Epub 2020 Oct 20.

Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.

Background: Video capsule endoscopy (VCE) revolutionized the diagnosis and management of obscure gastrointestinal bleeding, though the rate of detection of small bowel lesions by the physician is still disappointing. Our group developed a novel algorithm (CMEMS-Uminho) to automatically detect angioectasias which display greater accuracy in VCE static frames than other methods previously published. We aimed to evaluate the algorithm overall performance and assess its diagnostic yield and usability in clinical practice. Read More

View Article and Full-Text PDF
February 2021

The utility of faecal and urine biomarkers for small bowel diseases.

Curr Opin Gastroenterol 2021 May;37(3):284-294

Department of Gastroenterology, Tallaght University Hospital.

Purpose Of Review: Small bowel diseases pose a unique diagnostic and management challenge and often requires tertiary specialist referral. The use of biomarkers may provide a cheap, noninvasive tool to assess the small bowel in terms of diagnosis, offering a better way to triage referrals and select patients for early management. This review looks at the most recent evidence behind the use of several faecal and urine biomarkers for small bowel diseases. Read More

View Article and Full-Text PDF

Management of Non-Variceal Upper GI Bleeding in the Geriatric Population: An Update.

Curr Gastroenterol Rep 2021 Mar 25;23(4). Epub 2021 Mar 25.

Department of Medicine, Division of Gastroenterology & Nutrition, Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229-3900, USA.

Purpose Of Review: Upper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality in the geriatric (age > 65 years) population and presents a unique management challenge in the context of multiple medical comorbidities, polypharmacy, and increased risk of adverse outcomes and is confounded by an increased prevalence of obscure GI bleeds. A review of relevant guidelines, literature, and personal observations will enhance management strategies in the elderly.

Recent Findings: Non-variceal bleeding represents a significant proportion of upper GI bleeding (UGIB) in geriatric patients. Read More

View Article and Full-Text PDF

The role of early video capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi-center propensity score matching study.

J Gastroenterol Hepatol 2021 Mar 16. Epub 2021 Mar 16.

Division of Gastroenterology and Hepatology, School of Medicine, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Jiao Tong University, Renji Hospital, Shanghai, China.

Background And Aim: Video capsule endoscopy (VCE) is a first-line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. Read More

View Article and Full-Text PDF

Synchronous occurrence of myelodysplastic syndrome and a bleeding jejunal gastrointestinal stromal tumor in a patient with obscure gastrointestinal bleed.

J Cancer Res Ther 2021 Jan-Mar;17(1):269-271

Department of Surgical Oncology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.

The coexistence of gastrointestinal (GI) stromal tumors (GISTs) and other malignancies, both synchronous or metachronous, has been discussed extensively in literature. It has also been described that the frequency of malignancies among patients with GIST is significantly higher than that in the general population. We present a case report of a patient with synchronous occurrence of myelodysplastic syndrome (MDS) and a GIST who presented with chronic fatigue and an episode of syncope and was found to have obscure GI bleed. Read More

View Article and Full-Text PDF

Meckel's Diverticulum Bleeding Missed by the First but Detected by the Second Capsule Endoscopy.

J UOEH 2021 ;43(1):75-80

The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.

A 13-year-old boy was admitted to our hospital because of bloody stools. Although a Meckel's diverticulum (MD) was suspected, capsule endoscopy (CE) revealed no remarkable findings. Seven months later, he was admitted again because of rebleeding. Read More

View Article and Full-Text PDF
January 2021

A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire.

Clin Res Hepatol Gastroenterol 2021 Jan 28;45(6):101637. Epub 2021 Jan 28.

Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France. Electronic address:

Background And Aim: Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire.

Materials And Methods: Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Read More

View Article and Full-Text PDF
January 2021

A Novel Indocyanine Green Fluorescence-Guided Laparoscopic Technique to Map the Site of Obscure Gastrointestinal Haemorrhage.

Chirurgia (Bucur) 2021 Jan-Feb;116(1):89-101

The aim of our study was to explore the feasibility of a novel fluorescence-guided laparoscopic technique to localize the obscure GI haemorrhage, using the vascular wash-out properties of indocyanine green (ICG). Method: The feasability study included patients with previous surgical modifications of the gut architecture, qualified as an overt obscure GI bleeding with an urgent need to be localized and controlled. Five mL of ICG was injected intravenously and laparoscopic infrared inspection was performed 30 minutes after the dye was eliminated from the bloodstream. Read More

View Article and Full-Text PDF

Gene Therapy for Inherited Bleeding Disorders.

Semin Thromb Hemost 2021 Mar 26;47(2):161-173. Epub 2021 Feb 26.

Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Decades of preclinical and clinical studies developing gene therapy for hemophilia are poised to bear fruit with current promising pivotal studies likely to lead to regulatory approval. However, this recent success should not obscure the multiple challenges that were overcome to reach this destination. Gene therapy for hemophilia A and B benefited from advancements in the general gene therapy field, such as the development of adeno-associated viral vectors, as well as disease-specific breakthroughs, like the identification of B-domain deleted factor VIII and hyperactive factor IX Padua. Read More

View Article and Full-Text PDF

Early Growth Response Protein 1 Knockdown Alleviates the Cerebral Injury in Rats with Intracerebral Hemorrhage (ICH) via STAT3/NF-κB Pathway by Reducing RXRα Acetylation Level.

Neuroscience 2021 Feb 16. Epub 2021 Feb 16.

Ward 1 of Neurosurgery Department, China-Japan Friendship Hospital, Jilin University, China. Electronic address:

Brain EGR1 (early growth response protein 1) overexpression aggravates focal ischemic brain injury, but its role in intracerebral hemorrhage (ICH) induced cerebral injury remains obscure. In this study, a rat ICH model was established by injecting type VII collagenase into the brain, and EGR1 knockdown reversed the increase of hematoma area, neurological function score, brain water content, blood-brain barrier (BBB) permeability, inflammation, p300 and retinoid a X receptor-α (RXRα) protein levels, as well as RXRα acetylation level induced by ICH. EGR1 expression was up-regulated in primary brain microvascular endothelial cells (BMECs), neurons, and astrocytes after ICH induction, and the up-regulation was most significant in BMECs. Read More

View Article and Full-Text PDF
February 2021

Unique Endoscopic Presentation of "Reversed Reflux"-type Cameron Lesions.

Vincent Zimmer

Euroasian J Hepatogastroenterol 2020 Jul-Dec;10(2):103-104

Department of Medicine II, Saarland University Medical Center, Homburg, Germany.

As typical complications of hiatal hernias, Cameron lesions often go unnoticed in clinical practice, in particular, in patients with presumed overt and/or obscure upper gastrointestinal bleeding. However, albeit not yet systematically studied, Cameron lesions might be highlighted by novel image-enhanced endoscopic technologies, such as linked color imaging (LCI). Reminiscent of erosive reflux lesions, these lesions may present as reddish streaks, frank ulceration, and/or any other variation within this spectrum. Read More

View Article and Full-Text PDF
January 2021

Bochadek hernia: the utility of capsule endoscopy.

Rev Esp Enferm Dig 2021 Jan 25. Epub 2021 Jan 25.

Gastroenterology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal.

The authors report an unusual case of gastrointestinal bleeding with a challenging diagnosis, associated with a Bochdalek hernia. This clinical case highlights the role of capsule endoscopy both as a first-line exam in obscure gastrointestinal bleeding and as an alternative exam in cases of incomplete colonoscopy.  . Read More

View Article and Full-Text PDF
January 2021

Jejunal Dieulafoy's Lesion: A Systematic Review of Evaluation, Diagnosis, and Management.

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:2324709620987703

University of Missouri School of Medicine, Columbia, MO, USA.

Jejunal Dieulafoy's lesion is an exceedingly rare but important cause of gastrointestinal bleeding. It frequently presents as a diagnostic and therapeutic conundrum due to the rare occurrence, intermittent bleeding symptoms often requiring prompt clinical action, variability in the detection and treatment methods, and the risk of rebleeding. We performed a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding jejunal Dieulafoy's lesio from inception till June 2020. Read More

View Article and Full-Text PDF
January 2021

Memantine protects blood-brain barrier integrity and attenuates neurological deficits through inhibiting nitric oxide synthase ser1412 phosphorylation in intracerebral hemorrhage rats: involvement of peroxynitrite-related matrix metalloproteinase-9/NLRP3 inflammasome activation.

Neuroreport 2021 02;32(3):228-237

The Second Clinical Medical College of Nanchang University.

Memantine has demonstrated beneficial effects on several types of brain insults via therapeutic mechanisms mainly related to its activity as a receptor antagonist of N-methyl-d-aspartate. However, the influences of memantine on intracerebral hemorrhage (ICH) remain obscure. This research probed into the neurovascular protective mechanisms of memantine after ICH and its impacts on neuronal nitric oxide synthase (nNOS) ser1412 phosphorylation. Read More

View Article and Full-Text PDF
February 2021

Factors associated with bleeding after endoscopic variceal ligation for children.

Pediatr Int 2021 Jan 19. Epub 2021 Jan 19.

Nagoya University, Graduate School of Medicine Department of Gastroenterology and Hepatology, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi, 4668550, Japan.

Background: Endoscopic variceal ligation (EVL) is a widely accepted treatment for esophagogastric varices in patients with portal hypertension. It is used for urgent treatment and prophylactic treatment of esophagogastric varices not only in adults, but also in pediatric patients. However, major life-threatening adverse events such as early rebleeding can occur. Read More

View Article and Full-Text PDF
January 2021

Dieulafoys jejunal lesion as a source of lifethreating bleeding.

Vnitr Lek 2020 ;66(6):381-385

Dieulafoy`s lesion is a rare condition characterized by bleeding into gastrointestinal tract from minimaly eroded submucous artery. Mostly is localized in stomach in elderly polymorbid men, but can occure in entire gastrointestinal tract, in both sexes, in every age. It should be thought off as one of possible causes of obscure bleeding. Read More

View Article and Full-Text PDF
January 2021

Laparoscopic assisted balloon enteroscopy to detect obscure gastrointestinal bleeding sources missed by capsule endoscopy.

J Minim Access Surg 2021 Jan-Mar;17(1):104-107

Department of Emergency, Careggi University Hospital, Florence, Italy.

Jejunoileal neuroendocrine tumours (NETs) are frequently multifocal and represent a consistent source of obscure gastrointestinal bleeding (OGIB). We report the real-life case of a female presenting to our attention for severe episodes of haematochezia caused by multiple localisation of jejunoileal NETs. A discrepancy between pre-operative total body contrast-enhancement computed tomography scan and capsule endoscopy (CE) emerged, in terms of numbers of lesions, so that, as completeness, an intraoperative balloon-assisted enteroscopy (BAE) was carried out, leading to the detection of the multiple lesions missed during CE. Read More

View Article and Full-Text PDF
December 2020

Total control introducer-aided nasotracheal intubation using a videolaryngoscope in an anticipated difficult airway: a novel technique.

BMJ Case Rep 2020 Dec 13;13(12). Epub 2020 Dec 13.

Anaesthesiology, Dr RML Hospital and PGIMER, New Delhi, Delhi, India.

Nasotracheal intubation can be challenging due to undesirable incidence of nasal bleeding and soft tissue injuries. The bleeding can obscure glottis visualisation, increase the total intubation time, the risk of aspiration and oxygen desaturation. Total control introducer is a new airway adjunct with a flexible shaft, articulating tip and an intuitive depth control system, which can be used in difficult airway scenarios to improve the success of nasal intubations. Read More

View Article and Full-Text PDF
December 2020

Pan-enteric capsule for bleeding high-risk patients. Can we limit endoscopies?

Rev Esp Enferm Dig 2020 Dec 3. Epub 2020 Dec 3.

Servicio de Aparato Digestivo, Clínica Universidad de Navarra.

Obscure gastrointestinal bleeding is defined as bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy, being capsule endoscopy the next step in those patients. Some patients may be unsuitable for conventional endoscopy and performing a capsule pan-endoscopic test as a first line procedure might potentially reduce the number of endoscopies and their subsequent risk. The aim of our study was to analyse our experience with capsule endoscopy in the bleeding patient setting. Read More

View Article and Full-Text PDF
December 2020

Potential Role of Platelet-Activating C-Type Lectin-Like Proteins in Viper Envenomation Induced Thrombotic Microangiopathy Symptom.

Toxins (Basel) 2020 11 27;12(12). Epub 2020 Nov 27.

Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China.

Envenomation by viperid snakes may lead to severe bleeding, consumption coagulopathy, and thrombotic microangiopathy symptoms. The exact etiology or toxins responsible for thrombotic microangiopathy symptoms after snake envenomation remain obscure. Snake C-type lectin-like proteins (snaclecs) are one of the main non-enzymatic protein constituents in viper venoms, of which a majority are considered as modulators of thrombosis and hemostasis. Read More

View Article and Full-Text PDF
November 2020