From the Guidelines
Given the absence of symptoms for four years and the previously normal endoscopic evaluations, no immediate additional testing is necessary at this time. It's reassuring that you had a normal colonoscopy and endoscopy after experiencing melena (black, tarry stools) four years ago, with no recurrence since then. The most common causes of lower gastrointestinal bleeding, as outlined in a review article on the management of lower gastrointestinal bleeding 1, are diverticulosis, angiodysplasia, hemorrhoids, and ischemic colitis. However, melena typically indicates bleeding from the upper gastrointestinal tract, and since your previous workup was negative, the episode may have been due to a temporary condition that has resolved, such as a small ulcer or gastritis that has healed.
Key Considerations
- You should continue with age-appropriate colorectal cancer screening as recommended by your healthcare provider.
- If you experience any new episodes of melena, abdominal pain, unexplained weight loss, or changes in bowel habits, you should promptly consult your doctor for evaluation.
- Maintaining a healthy lifestyle with a balanced diet, avoiding excessive use of NSAIDs like ibuprofen which can cause GI bleeding, limiting alcohol consumption, and not smoking can help prevent future gastrointestinal issues.
Ongoing Monitoring
It is essential to remain vigilant for any signs of gastrointestinal bleeding or other issues, given the increased incidence of diverticulosis and angiodysplasia with age, as noted in the study 1. Regular check-ups with your healthcare provider can help identify any potential problems early on.
From the Research
Melena and Normal Coloscopy and Endoscopy Results
- The user had melena 4 years ago, but normal coloscopy and endoscopy results were found 2, 3, 4, 5, 6.
- There has been no recurrence of melena since then.
- Studies have shown that the diagnostic yield of colonoscopy to evaluate melena after a nondiagnostic EGD is low, ranging from 4.8% to 37% 3, 6.
- The presence of melena can predict bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) 5.
- Further evaluation, such as colonoscopy, may be necessary to determine the source of melena in patients with nondiagnostic upper endoscopy 3, 4, 6.
Potential Sources of Melena
- The right colon is a common location of pathology in patients with melena and nondiagnostic upper endoscopy 6.
- Small bowel contrast studies, flexible sigmoidoscopy, or barium enema alone may not be effective in revealing a source of melena 6.
- Capsule endoscopy may be useful in detecting bleeding sources in the small intestine, especially in patients with melena 2, 5.
Clinical Implications
- Patients with melena and nondiagnostic upper endoscopy may require further evaluation to determine the source of bleeding 3, 4, 6.
- The presence of melena can guide the choice of diagnostic tests and procedures, such as colonoscopy or capsule endoscopy 2, 5.
- Clinicians should consider the potential for bleeding in the proximal small intestine in patients with melena and OGIB 5.