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Recurrent epigastric pain with obscure GI bleeding; think beyond the bowel?
  1. Maxworth Chuen-Wei Hu1,
  2. Philip Victor Kaye1,
  3. Ian James Beckingham2,
  4. Martin Wynn James1
  1. 1NIHR Digestive Diseases Biomedical Research Unit, Queen's Medical Centre, Nottingham, UK
  2. 2Division of Hepatico-pancreaticobiliary Surgery, Queen's Medical Centre, Nottingham, UK
  1. Correspondence to Dr Maxworth Chuen-Wei Hu, Nottingham University Hospitals, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK; maxworth.hu{at}gmail.com

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Clinical presentation

A 74-year-old male patient presented with epigastric pain, recurrent melaena and anaemia. His medical history included myocardial infarction, rheumatoid arthritis, diet-controlled type 2 diabetes and recent endovascular infrarenal abdominal aortic aneurysm repair. He was taking aspirin, omeprazole, methotrexate and sulfasalazine. He had stopped smoking for 10 years and was a teetotaller. Upper gastrointestinal (GI) endoscopy did not demonstrate any stigmata of recent haemorrhage. No contrast leak was demonstrated on mesenteric arteriography. CT angiography also did not reveal any contrast extravasation or aortoenteric …

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