Recurrent obscure gastrointestinal bleeding.

Routine diagnostic studies can locate the source of gastrointestinal bleeding in the vast majority of persons. In approximately 5 percent of persons, however, the source remains obscure despite sophisticated studies. Our inability to localize the source of bleeding in these individuals illustrates the limits of available diagnostic technology. In an elderly patient who requires repeated diagnostic studies, attendant morbidity can be a limiting factor in the aggressive pursuit of the source of bleeding. In this paper, we discuss the usefulness of empiric hormonal therapy for the frail elderly patient who would be a poor surgical candidate or who could not tolerate repeated invasive procedures. Obscure intestinal bleeding is known to remit spontaneously. In the individual patient, therefore, it is not possible to ascribe the cessation of bleeding to oral hormonal treatment. Because randomized, controlled studies have not addressed this question, clinicians caring for a frail older person bleeding from an obscure lesion should consider empiric hormonal therapy as a reasonable treatment option.