Obscure gastrointestinal bleeding (OGIB) is defined as gastrointestinal bleeding from a source or induced by a cause that cannot be determined even after performing an upper or lower gastrointestinal endoscopy. It is an incurable disease that can cause repeated bloody stools and anemia with no identifiable cause, and may require frequent blood transfusions. Although the pathogenesis of OGIB remains poorly understood, doctors hypothesize that in most cases the bleeding originates in the small intestine.
An overall cumulative rate of rebleeding of 41.7%, during the 5 years following endoscopy.
Bleeding frequency, anticoagulant intake, positive balloon-assisted enteroscopy (BAE), iron supplementation, and liver cirrhosis are identified as independent predictors of recurrence in these patients with OGIB.
Capsule (or videocapsule) endoscopy (CE) is a non-invasive procedure for evaluating OGIB. Previous studies have shown that patients with severe comorbidities have a higher rate of positive diagnosis by CE, in other words, a higher risk of mucosal ruptures, vascular lesions, tumors or blood retention. Moreover, for OGIB in which the initial endoscopy fails to identify bleeding lesions, repeated endoscopies, always of the CE type, make it possible to detect the lesions at a higher rate. However, to date there are still few data on signs of OGIB detected by CE and the risk of new bleeding.
The study: Dr. Koji Otani’s team from Osaka University followed 389 patients who underwent CE for OGIB and assessed the risk of long-term rebleeding. Analysis of monitoring data reveals that:
- the overall cumulative rate of rebleeding during the 5 years following CE is 41.7%;
- patients with positive endoscopy results, ie, signs of various bowel lesions, have a cumulative risk of recurrence of 48.0%;
- patients who underwent therapeutic intervention because of positive CE results have a 31.8% risk of recurrence, post-intervention.
The main predictors of new bleeding, in addition to already frequent gastrointestinal bleeding (active OGIB), include:
- taking anticoagulants,
- positive balloon-assisted enteroscopy after EC,
- iron supplementation without therapeutic intervention;
- cirrhosis of the liver is both a predictor of recurrence in patients with OGIB, but also of the severity of complications.
Thus, capsule endoscopy can be used to diagnose and guide therapeutic intervention in case of injury.
And if endoscopy does not detect any lesion, follow-up of patients with symptoms remains essential.
Because the study warns of this high rate of bleeding in patients with OGIB and specifies the predictors of new bleeding, and therefore of therapeutic intervention. With, the objective of better care for these patients whose current treatment can be terribly taxing.