Overt Small Bowel Bleeding in the Older Adult

Published:November 01, 2022DOI:


      • Older adults are at higher risk for small bowel bleeding due to angiodysplasias, which can result in hemodynamically significant presentations.
      • Although only 5% of gastrointestinal bleeding arises from the small bowel, it is the most common source of occult bleeding.
      • In older adults, small bowel ulcers, vascular abnormalities, and nonsteroidal anti-inflammatory drug–induced enteropathy are the most prevalent causes of bleeding in the gastrointestinal tract.
      • Chronic renal failure, aortic stenosis, chronic conditions of the respiratory system, use of warfarin, venous thromboembolism, and female gender have all become recognized risk factors for the increased incidence of small bowel angiodysplasias.


      Gastrointestinal bleeding emanating from the small bowel may be overt or obscure, requiring an evidence-based approach by the clinician to identify source in a timely manner. Older adults are at higher risk for small bowel bleeding due to angiodysplasias, which can result in hemodynamically significant presentations. Using endoscopic modalities and other imaging techniques in a step-wise fashion is vital to localize source of bleeding. This case presents an older adult female with acute on chronic anemia and overt bleeding of suspected small bowel source, with subsequent diagnostic pathway and successful endoscopic intervention following current guidelines.


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      Anna W. Boone, PhD, ANP-PC, is a nurse practitioner at Rockingham Gastroenterology, Cone Health, Reidsville, NC, and can be contacted at [email protected] .


      Chelsea L. Carlan, MSN, AGNP-C, is a nurse practitioner at Reidsville Gastroenterology, Cone Health, Reidsville, NC.


      Leslie S. Lewis, MHS, PA-C, is a physician assistant at Rockingham Gastroenterology, Cone Health, Reidsville, NC.