5. Hematemesis, Melena, and Occult Bleeding/Anemia

  1. John N. Plevris MD, PhD, FRCPE, FEBGH3 and
  2. Colin W. Howden MD, FRCP (Glasg.), FACP, AGAF, FACG4
  1. Grigorios I. Leontiadis MD, PhD1 and
  2. Virender K. Sharma FASGE, FACG, AGAF2

Published Online: 29 NOV 2011

DOI: 10.1002/9781444346381.ch5

Problem-Based Approach to Gastroenterology and Hepatology

Problem-Based Approach to Gastroenterology and Hepatology

How to Cite

Leontiadis, G. I. and Sharma, V. K. (2012) Hematemesis, Melena, and Occult Bleeding/Anemia, in Problem-Based Approach to Gastroenterology and Hepatology (eds J. N. Plevris and C. W. Howden), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346381.ch5

Editor Information

  1. 3

    Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

  2. 4

    Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Author Information

  1. 1

    McMaster University Department of Medicine, Division of Gastroenterology, Health Sciences Centre, Hamilton, ON, Canada

  2. 2

    Arizona Center for Digestive Health, Gilbert, AZ, USA

Publication History

  1. Published Online: 29 NOV 2011
  2. Published Print: 17 JAN 2012

ISBN Information

Print ISBN: 9781405182270

Online ISBN: 9781444346381



  • peptic ulcer bleeding;
  • endoscopic hemostasis;
  • proton pump inhibitor;
  • Helicobacter pylori, non steroidal anti-inflammatory drug;
  • iron deficiency anemia;
  • obscure gastrointestinal bleeding;
  • capsule endoscopy;
  • small bowel enteroscopy


A 48-year-old woman presented with hematemesis and tachycardia. She was resuscitated with intravenous fluids and treated with an intravenous proton pump inhibitor (PPI). Endoscopy demonstrated an adherent clot in the duodenum. Removal of the clot revealed an ulcer with blood oozing. Hemostasis was achieved after epinephrine injection. The patient was subsequently treated with high-dose intravenous infusion of a PPI and had an uneventful recovery. A 72-year-old man with iron deficiency anemia underwent upper and lower endoscopy for evaluation. Upper endoscopy demonstrated a small hiatus hernia; colonoscopy demonstrated two, small tubular adenomas. Biopsies from the small intestine were negative for celiac sprue. He was prescribed oral iron, but 6 weeks later still had iron deficiency anemia. Capsule endoscopy to evaluate the small intestine revealed a mid-small bowel ulcerated mass lesion that was confirmed on CT enterography. No additional extraintestinal lesion was found. Surgical resection of the small intestinal mass found it to be a carcinoid tumor.