In the past it was believed that asymptomatic patients with obscure-occult bleeding over 60 years of age who have undergone negative colonoscopy and upper endoscopy should only undergo small bowel examination with enteroclysis or SBFT to effectively rule out significant lesions, particularly if a response to oral iron replacement therapy was observed (Rockey and Cello, 1993.). However, in our view, this was similar to treating an automobile oil leak with oil replacement only, rather than fixing its source. In clinical practice, an occult malignancy may be missed and/or a bleeding lesion progress causing increased morbidity and mortality. Patients with OGIB and comorbid disease, and/or those who require blood transfusions, should certainly be subject to a more extensive evaluation. Our current algorithmic approach to patients with OGIB is outlined in Figure 59-1.

After they have undergone negative upper endoscopy and colonoscopy with ileoscopy (repeated if initially negative), enteroscopy, preferably performed with use of an overtube, is our standard approach (O'Loughlin and Barkin, 2004). Enteroscopes vary in length from 220 to 250 cm and with the use of fluoroscopy and an overtube, they can generally reach to a depth of 100 to 110 cm beyond the ligament of Treitz. However a physician's choice of instrument and technique (pediatric colonoscopes/use of

History/physical (exclude NSAIDS) Repeat EGD/Colonoscopy with Ileoscopy—Treat

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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