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Objective: Studies on unexplained gastrointestinal bleeding (GIB) are lacking. We aimed to study the clinical outcomes of patients with unexplained GIB and to determine the incidence of obscure GIB., Material and Methods: A population-based study on all patients undergoing endoscopy at the National University Hospital of Iceland in 2010. Indications, results of endoscopies and drug history were prospectively registered with a follow-up of 3 years. A national pharmaceutical database containing prescription data was utilized. Patients were categorized into unexplained overt and occult GIB and obscure GIB. Patients undergoing endoscopy and without GIB acted as controls., Results: Of 2471 patients undergoing endoscopy, 11% had unexplained GIB. Of those, 46% had unexplained overt GIB, 44% had unexplained occult GIB and 11% had obscure GIB. Multivariate analysis showed that patients with unexplained GIB and unexplained overt GIB had greater odds of NSAID use than controls, OR 1.8 (CI 1.03-3.03) and OR 2.0 (CI 1.01-3.77), respectively. Warfarin was strongly associated with all bleeder groups, OR 4-4.8. The incidence of obscure GIB was 10/100,000 inhabitants annually. Two (0.8%) patients were diagnosed with colon cancer 16 and 30 months after the index colonoscopy. Of patients with unexplained overt, unexplained occult GIB and controls, 5%, 6% and 3.5% (NS) had another overt bleeding episode, during the study period., Conclusions: NSAIDs and warfarin seem to play an important role in unexplained GIB. The incidence of obscure GIB is low and missed cancers are very rare. The probability of a repeat bleeding episode is similar to that of controls.

Objective: According to clinical guidelines, a colonoscopy is recommended after an attack of diverticulitis in order to exclude colorectal cancer (CRC). This is based on studies prior to the use of computerized tomography (CT) for confirmation of the diagnosis. We aimed to investigate the findings of a subsequent colonoscopy after an attack of uncomplicated diverticulitis., Material and Methods: The study cohort consisted of all patients with the diagnosis of uncomplicated diverticulitis, who underwent a subsequent colonoscopy 6-8 weeks later during a 6-years period in the National University Hospital of Iceland. The diagnosis of diverticulitis was based on clinical symptoms verified with a CT of the abdomen. Relevant clinical information was obtained from medical records and from the Icelandic Cancer Registry., Results: A total of 282 patients had uncomplicated diverticulitis and 199 patients underwent endoscopy. Two patients had CRC (0.7%), diagnosed with diverticulitis but did not recover clinically. All other patients recovered clinically. Colonic polyps were found in 33 of 195 (17%) cases. In 19/33 (58%) cases the histology demonstrated hyperplastic polyps, and in 13/33 (39%) adenoma with mild dysplasia. Only 1/33 (3%) of the colonic polyps were >1 cm in size., Conclusions: Among patients experiencing an attack of uncomplicated diverticulitis the frequency of CRC was equal to what might be expected compared to the average risk in the population. In these patients a routine colonoscopy in the absence of other clinical signs of CRC seems hardly necessary, if the clinical course is uneventful and the patient recovers.