Predictors of positive endoscopic findings in hospitalized patients with occult gastrointestinal bleeding

Abstract

Anemia with occult gastrointestinal bleeding (OGIB) is a common reason for inpatient gastroenterology consultation and endoscopy. However, the utility of inpatient endoscopy in this setting is unclear. The aim of this paper is to determine variables that predict positive endoscopic examinations for inpatients presenting with anemia and OGIB. We performed a prospective observational study of consecutive hospitalized patients between March 2013 and April 2014 with anemia and OGIB. For patients undergoing inpatient endoscopic evaluation, logistic regression was used to determine which variables were associated with detecting etiology of OGIB. An occult bleeding score (OBS) was created using receiver operating characteristics and area under the curve (AUC) analysis to predict detection of bleeding source and need for endoscopic intervention. Of the 74 patients identified, 55 (74%) underwent endoscopic evaluation, of whom 28 patients had a source of OGIB identified. Patients with malignancy (OR 7.25, 95%CI 1.06-144) were more likely to have a bleeding source identified on endoscopy, whereas patients with higher admission hemoglobin levels were less likely to have a detected source (OR 0.62, 95%CI 0.41-0.86). The OBS was constructed by assigning a point each for malignancy and admission hemoglobin <8.2 g/dL. The OBS predicted detection of etiology of bleeding and endoscopic intervention with an AUC of 0.79 and 0.75. The yield of endoscopy in determining a bleeding source in patients with OGIB is significant particularly in patients with malignancy or a low hemoglobin level. A simple score can assist in determining whether inpatient endoscopy is warranted in this population.

Keywords

• Gastrointestinal hemorrhage, occult blood, guaiac, gastrointestinal endoscopy