Kim Ji Hyun, Nam Seung-Joo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, South Korea.
World J Clin Cases. 2023 Jun 16;11(17):3949-3957. doi: 10.12998/wjcc.v11.i17.3949.
Obscure gastrointestinal bleeding (OGIB) has traditionally been defined as gastrointestinal bleeding whose source remains unidentified after bidirectional endoscopy. OGIB can present as overt bleeding or occult bleeding, and small bowel lesions are the most common causes. The small bowel can be evaluated using capsule endoscopy, device-assisted enteroscopy, computed tomography enterography, or magnetic resonance enterography. Once the cause of small-bowel bleeding is identified and targeted therapeutic intervention is completed, the patient can be managed with routine visits. However, diagnostic tests may produce negative results, and some patients with small bowel bleeding, regardless of diagnostic findings, may experience rebleeding. Predicting those at risk of rebleeding can help clinicians form individualized surveillance plans. Several studies have identified different factors associated with rebleeding, and a limited number of studies have attempted to create prediction models for recurrence. This article describes prediction models developed so far for identifying patients with OGIB who are at greater risk of rebleeding. These models may aid clinicians in forming tailored patient management and surveillance.
隐匿性胃肠道出血(OGIB)传统上被定义为经双向内镜检查后仍未明确出血源的胃肠道出血。OGIB可表现为显性出血或隐匿性出血,其中小肠病变是最常见的病因。小肠可通过胶囊内镜、器械辅助小肠镜检查、计算机断层扫描小肠造影或磁共振小肠造影进行评估。一旦确定小肠出血的病因并完成针对性的治疗干预,患者可进行常规随访。然而,诊断检查可能会产生阴性结果,并且一些小肠出血患者,无论诊断结果如何,都可能再次出血。预测有再出血风险的患者有助于临床医生制定个性化的监测计划。多项研究已确定了与再出血相关的不同因素,并且有少数研究尝试创建复发预测模型。本文介绍了目前已开发的用于识别有更高再出血风险的OGIB患者的预测模型。这些模型可能有助于临床医生形成个性化的患者管理和监测方案。