A previously fit 27 year old man presented to the gastroenterologists with a three month history of tiredness. There was no history of haematemesis, but he did complain of the passage of black stools on rare occasions. On examination temperature, pulse, and blood pressure were normal. There was no lymphadenopathy. Chest and abdominal examination were normal.

Laboratory investigations revealed a picture of iron deficiency with a haemoglobin concentration of 92 g/l, mean corpuscular volume 70.5 fl, mean corpuscular haemoglobin 21.8 pg, platelets 262 × 10⁹ /l, and an erythrocyte sedimentation rate of 13 mm/hour.

Upper gastrointestinal endoscopy revealed mild gastritis. He was negative for Helicobacter pylori and distal duodenal biopsies were normal. Chest radiography and colonoscopy were normal. He then underwent a barium follow through (see fig 1).

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Figure 1

Barium follow through.