Actitud ante el paciente con hemorragia digestiva de origen oscuro

Resum

Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract that persists or recurs without an obvious etiology after upper endoscopy and colonoscopy. Obscure bleeding may be either overt, when the blood is visible, or occult, when it is detected by a positive fecal occult blood test and/or iron-deficiency anaemia with no evidence of visible blood loss. In 75 percent of these patients, the blood source is in the small bowel, and its search is a challenge for gastroenterologists due to the difficulties in evaluating it. The remaining 25% represent missed lesions in the previous endoscopies. The development of new medical imaging techniques such as capsule endoscopy and balloon-assisted enteroscopy has led to a change in the approach to this pathology, although some issues remain controversial. We present a revision of OGIB, including all diagnostic procedures available for its evaluation, different management strategies as well as treatment options.