THE DIAGNOSTIC challenge of gastrointestinal bleeding is one that confronts physicians constantly. Even the most astute clinician aided by skillfully used radiographic and endoscopic procedures may be defeated in his search for the location and cause of a hemorrhage. The frequency with which the cause of gastrointestinal bleeding remains undiagnosed has been emphasized many times. In some series of carefully studied patients, failure to find the source of a hemorrhage has ranged from 15% to 40%.1-3 When bleeding has been characterized by melena without hematemesis inability to find the cause has been even more striking, as high as 52% in one series.4 Even surgical exploration frequently fails to disclose the cause of melena. Retzlaff et al5 reported that the source of the bleeding was discovered at operation in only 30% of a group of patients with melena.
Because of the need for greater accuracy in locating these
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 71
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.