title: Etiology and management of obscure gastrointestinal bleed--an appraisal from eastern India.
abstract: OBJECTIVE
  Forty patients (mean age 45 years; 24 men) attending a tertiary care hospital in eastern India during the period 1996-2000 were investigated to evaluate the etiology and clinical spectrum of obscure gastrointestinal bleed.
  
  
  RESULTS
  The patients presented to hospital after mean symptom duration of 2.5 years. They had received an average of 15 units of blood transfusion. Most patients presented with recurrent melena (85%); all had iron-deficiency anemia. A total of 230 investigations (89 gastroscopies, 54 colonoscopies, 25 double-contrast meal and follow-through studies, 14 small bowel enemas, 24 radionuclide scans, 16 mesenteric angiographies and 8 intraoperative endoscopies) yielded positive diagnosis in 87.5% of cases. The diseases encountered were small bowel and colonic angiodysplasias (32.5%), ileal Crohn's disease (20%), intestinal tuberculosis (10%), intestinal tumors (10%), nonspecific small bowel ulcers and strictures (7.5%), Meckel's diverticulum (5%) and hemobilia (2.5%). The etiology remained obscure in 5 (12.5%) cases. Overall success of surgery was 63%; in-hospital mortality was 7.5%.
  
  
  CONCLUSIONS
  Though obscure gastrointestinal bleed is commonly caused by angiodysplasias, it can be an atypical presentation of Crohn's disease.
authors.affiliation: Department of Gastroenterology, Seth Sukhlal Karnani Memorial Hospital and Institute of Postgraduate Medical Education and Research, Kolkata.
authors.forename: G
authors.initials: G
authors.lastname: Ray
authors.forename: P K
authors.initials: PK
authors.lastname: Banerjee
authors.forename: U C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: K
authors.initials: K
authors.lastname: Dhar
authors.forename: B B
authors.initials: BB
authors.lastname: Pal
authors.forename: A D
authors.initials: AD
authors.lastname: Biswas
authors.forename: U
authors.initials: U
authors.lastname: Das
authors.forename: M L
authors.initials: ML
authors.lastname: Saha
authors.forename: A N
authors.initials: AN
authors.lastname: Acharya
authors.forename: S
authors.initials: S
authors.lastname: Majumdar
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012307:Risk Factors