InvestigationsPotential resultsClinical management plan: abnormal results
Check haemoglobin and RBC indices
Check clotting and haematinics if heavy bleeding has occurred
AbnormalFollow treatment for abnormal blood results (pages 2–3).
OGD and colonoscopyRadiation-induced telangiectasia in the colon or terminal ileum
  1. Do not biopsy irradiated areas.

  2. Optimise bowel function and stool consistency.

  3. If bleeding is not affecting quality of life, reassure.

  4. If bleeding affects quality of life, stop/reduce anticoagulants if possible and consider oral sucralfate.

  5. Discuss and refer to a specialist centre for treatment to ablate telangiectasia:

    1. hyperbaric oxygen therapy

    2. thermal therapy, eg, APC

  6. Consider referral to a specialist centre for experimental therapy within the context of a clinical trial: thalidomide, vitamin A, tranexamic acid, RFA.

Primary inflammatory bowel disease
  1. Send stool culture.

  2. If mild or moderate, refer within 2 weeks to a gastroenterologist.

    If severe, this is an emergency—discuss immediately with a gastroenterologist.

Diverticular bleedingThis is an emergency
Discuss immediately with a GI surgeon.
Upper GI source for bleedingThis is an emergency
Discuss immediately with a gastroenterologist.
Newly diagnosed neoplasia
2nd primary/tumour recurrence/advanced polyp
Refer urgently to the appropriate oncology team requesting an appointment within 2 weeks.
If all tests are negative, but symptoms persist
  1. Discuss with supervising gastroenterologist.

  2. Consider capsule endoscopy (following use of a patency capsule—high risk of strictures).

  3. Consider angiography.

  4. Ask GP to monitor Hb as clinically indicated.

  • APC, argon plasma coagulation; GI, gastrointestinal; GP, general practitioner; OGD, oesophago-gastroduodenoscopy; RBC, red blood cell; RFA, radiofrequency ablation.