From the Guidelines
You should still consult with a healthcare provider for a follow-up evaluation, even if you experienced melena 4 years ago and had normal test results, as melena is a significant symptom indicating upper gastrointestinal bleeding. According to the definition provided by 1, melena refers to the passage of black tarry stools, which is a sign of upper gastrointestinal bleeding. Although your tests were normal at the time, it's possible that the bleeding had stopped before testing or was intermittent. Common causes of melena include peptic ulcers, gastritis, esophageal varices, or medication side effects, particularly NSAIDs like ibuprofen or aspirin.
The British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults, as outlined in 1, suggest that further investigation is warranted if there is any evidence of active undiagnosed pathology, such as ongoing weight loss or chronic unexplained diarrhea, persistently elevated inflammatory markers, and the persistence or recurrence of iron deficiency anaemia. Although these guidelines are specifically for iron deficiency anaemia, they highlight the importance of investigating potential underlying causes of gastrointestinal bleeding.
Given that you haven't had any recurrence of symptoms in the past 4 years, the issue may have resolved, but it's still worth mentioning to your doctor during your next visit. They might recommend preventive measures such as:
- Avoiding NSAIDs if you're prone to gastric irritation
- Limiting alcohol consumption
- Considering protective medications like proton pump inhibitors if you have risk factors The absence of ongoing symptoms is reassuring, but understanding the original cause could help prevent future episodes. As stated in 1, the diagnostic yield of small bowel examination by capsule endoscopy is high in recurrent iron deficiency anaemia unexplained by a negative capsule endoscopy, and the most common findings are vascular malformations and Crohn’s disease.
It's essential to note that the guidelines provided in 1 are for the management of iron deficiency anaemia, but they emphasize the importance of investigating potential underlying causes of gastrointestinal bleeding, which is relevant to your case. A follow-up evaluation with your healthcare provider is crucial to determine the best course of action and to rule out any potential underlying conditions that may have caused the melena.
From the Research
Melena and Its Causes
- Melena, which is the passage of black, tarry stools, can be caused by bleeding from various sources in the gastrointestinal tract 2.
- A study found that colonoscopy can detect suspected bleeding sources in 4.8% of patients with melena, which is more frequent than in a control group 2.
Diagnostic Yield of Colonoscopy
- The diagnostic yield of colonoscopy to investigate melena after a nondiagnostic EGD is low, with a suspected bleeding source found in only 4.8% of patients 2.
- However, patients with melena are at increased risk of colorectal cancer, and colonoscopy can potentially be performed electively in stable patients without continued bleeding 2.
Treatment and Management
- Proton pump inhibitors (PPIs) such as omeprazole can be effective in reducing gastric acid secretion and preventing NSAID-induced gastrointestinal damage 3, 4.
- A study compared the efficacy of oral omeprazole versus intravenous omeprazole in decreasing the risk of rebleeding in peptic ulcer patients, and found that oral PPIs can be as effective as intravenous PPIs 5.
- However, the concomitant use of PPIs with certain medications such as erlotinib should be avoided due to reduced pharmacokinetic exposure 6.