**3. Clinical presentation**

Patients with mid-GI bleeding generally present with melena, occult gastrointestinal bleeding (anemia with heme-positive stool), or iron deficiency anemia. Sometimes, they may present with hematochezia as well when there is brisk mid-gut bleeding. Hematemesis is rare but can happen if bleeding occurs proximal to the ligament of Treitz. Patients can have abdominal pain, constipation, diarrhea, or constitutional symptoms like fever, anorexia, or weight loss depending on the underlying etiology. Symptoms (fatigue, shortness of breath, dysphagia due to esophageal web) and signs (pallor of conjunctiva, atrophic glossitis, and koilonychia) can be present depending on the severity and chronicity of iron deficiency anemia [14]. Patients may give history of receiving multiple blood transfusions acutely, subacutely, or chronically despite having multiple endoscopies, colonoscopies, and imaging studies.
