Prevalence of mid-gastrointestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients.
BACKGROUND
Video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) enable the detection of small intestinal lesions.


OBJECTIVE
To examine causes of acute overt gastrointestinal (GI) bleeding and the prevalence of mid-GI bleeding, defined as small intestinal bleeding from the ampulla of Vater to the terminal ileum, in a multi-center experience in Japan in the VCE/DBE era.


METHODS
Data were collected retrospectively from consecutive patients with acute overt GI bleeding in ten participating hospitals. All patients were examined by esophagogastroduodenoscopy and/or colonoscopy. When the source of bleeding was not identified after these procedures, patients suspected to have mid-GI bleeding were referred to our hospital and VCE/DBE was performed to determine the source of bleeding.


RESULTS
Of the 1044 patients with acute overt GI bleeding, 524 (50.2%) patients were diagnosed with upper GI bleeding, 442 (42.3%) with lower GI bleeding, and 13 (1.2%) with mid-GI bleeding. Gastric ulcer was the most common cause of bleeding (20.4%). Among cases of mid-GI bleeding, ulcers were found in 4 (30.8%) patients, erosions in 3 (23.1%), angiodysplasia in 3 (23.1%), submucosal tumor in 2 (15.4%), and hemangioma in one (7.7%). Seven lesions were located in the jejunum, 5 in the ileum, and one in both the jejunum and ileum. Analysis of age-related cause showed that the prevalence of mid-GI bleeding among younger patients under 40 years of age was higher (5%) than in other age groups (1-2%).


CONCLUSIONS
mid-GI bleeding is rare among Japanese patients with acute overt GI bleeding.
Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 asahimachi, Abenoku, Osaka 545-8585, Japan.
Hirotoshi
H
Okazaki
Yasuhiro
Y
Fujiwara
Satoshi
S
Sugimori
Yasuaki
Y
Nagami
Natsuhiko
N
Kameda
Hirohisa
H
Machida
Hirokazu
H
Yamagami
Tetsuya
T
Tanigawa
Masatsugu
M
Shiba
Kenji
K
Watanabe
Kazunari
K
Tominaga
Toshio
T
Watanabe
Nobuhide
N
Oshitani
Tetsuo
T
Arakawa
D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D003108:Colonic Diseases / Q000175:diagnosis / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004935:Esophageal Diseases / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012002:Rectal Diseases / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000175:diagnosis / Q000453:epidemiology