From the Research
The sensitivity of Digital Rectal Examination (DRE) for detecting gastrointestinal bleeding is relatively low, and it should not be relied upon as the sole diagnostic test for GI bleeding. The most recent and highest quality study that directly addresses the sensitivity of DRE for GI bleeding is not provided in the given evidence, however, based on the available information, DRE can miss many cases of GI bleeding, particularly when bleeding is intermittent or in small amounts. While a positive DRE (finding blood on the examining finger) is helpful in confirming GI bleeding, a negative DRE does not rule out significant hemorrhage. This limited sensitivity occurs because blood must be present in the rectum at the time of examination to be detected, and many upper GI bleeds or right-sided colonic bleeds may not have blood reaching the rectum at the moment of examination. For this reason, DRE should be considered as just one component of a comprehensive evaluation for suspected GI bleeding, alongside other more sensitive tests such as fecal occult blood testing, endoscopy, or CT angiography depending on the clinical scenario, as discussed in 1 and 2. Despite its limitations, DRE remains a valuable initial bedside examination that can provide immediate information and should be performed in patients with suspected GI bleeding, as it can assist clinicians with clinical management decisions and reduce admissions, endoscopies, and medical therapy in these patients, as shown in 3. Some studies, such as 4 and 5, provide information on the clinical utilization of DRE and fecal occult blood testing, but they do not directly address the sensitivity of DRE for GI bleeding. Therefore, DRE should be used in conjunction with other diagnostic tests to ensure accurate diagnosis and effective management of GI bleeding, prioritizing morbidity, mortality, and quality of life as the outcome.