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Positive fecal occult blood test (FOBT), fecal immunochemical test (FIT), or iron deficiency anemia in an adult with no visible fecal blood loss
2–6% of patients in screening programs have a positive FOBT or FIT
2% of men and 5% of women have iron deficiency anemia
In premenopausal women
In men and postmenopausal women
Most common causes
Neoplasms
Vascular abnormalities (angioectasias)
Acid-peptic lesions
Infections (nematodes [especially hookworm], tuberculosis)
Medications (especially NSAIDs or aspirin)
Inflammatory bowel disorder or malabsorption (celiac disease)
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Capsule endoscopy is recommended as the initial study
Colonoscopy with or without upper endoscopy is indicated
For all adults with positive FOBT or FIT test or iron deficiency anemia
For those with family history of GI cancer
For premenopausal women and younger men with GI symptoms
For women with anemia disproportionate to the estimated menstrual blood loss
Colonoscopy should be done first unless upper GI tract symptoms are present
Upper endoscopy indicated in patients with upper GI tract symptoms or iron deficiency anemia after nondiagnostic colonoscopy
If a small intestine source is identified, push enteroscopy, balloon-assisted enteroscopy, abdominal CT, angiography, or laparotomy are pursued, as indicated
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