Middle gastrointestinal bleeding (MGIB) is considered when the source is located between the ampulla of Vater and the ileocecal valve. MGIB should be considered in patients with occult obscure bleeding and profound anemia or in patients with overt obscure bleeding who have a negative upper endoscopy and colonoscopy. Patients younger than 40 years old are more prone to have a Meckel's diverticulum, Crohn's disease or other forms of inflammatory bowel disease, Dieulafoy's lesions, or small bowel tumors, while older patients present with vascular lesions or NSAID‐related enteropathy. In patients with overt bleed, if they present with hematemesis, then repeat upper endoscopy or push enteroscopy to reach the ligament of Treitz should be performed. If this is negative, or the patient presented with other type of bleeding, massive bleeding would indicate angiography to detect the bleeding area, otherwise, repeat colonoscopy should be considered and, if negative, proceed immediately to capsule endoscopy. In those with occult bleed, after negative repeat upper endoscopy and colonoscopy, capsule endoscopy should be performed.