Diagnostic and therapeutic considerations for obscure gastrointestinal bleeding in patients with chronic kidney disease

• Type of Material: Article
• Authors: Mayssan Muftah, Emory University; Ramzi Mulki, Emory University; Tanvi Dhere, Emory University; Steven Keilin, Emory University; Saurabh Chawla, Emory University
• Language: English
• Date: 2019-03-01
• Publisher: Hellenic Society of Gastroenterology
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Hellenic Society of Gastroenterology.
• License: Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.20524/aog.2018.0341
• Title of Journal or Parent Work: Annals of Gastroenterology
• ISSN: 1108-7471
• Volume: 32
• Issue: 2
• Start Page: 113
• End Page: 123
• Keywords: angiodysplasia; arteriovenous malformations; Obscure gastrointestinal bleeding; chronic kidney disease; small-bowel bleeding
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Recurrent obscure gastrointestinal bleeding amongst patients with chronic kidney disease is a challenging problem gastroenterologists are facing and is associated with an extensive diagnostic workup, limited therapeutic options, and high healthcare costs. Small-bowel angiodysplasia is the most common etiology of obscure and recurrent gastrointestinal bleeding in the general population. Chronic kidney disease is associated with a higher risk of gastrointestinal bleeding and of developing angiodysplasia compared with the general population. As a result, recurrent bleeding in this subgroup of patients is more prevalent and is associated with an increased number of endoscopic and radiographic procedures with uncertain benefit. Alternative medical therapies can reduce re-bleeding; however, more studies are needed to confirm their efficacy in this subgroup of patients.