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Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.

ABSTRACT: Recent data imply young patients (age ?50 years) undergoing small-bowel (SB) capsule endoscopy (CE) for iron deficiency anaemia (IDA) show higher diagnostic yield (DY) for sinister pathology. We aimed to investigate DY of CE in a large cohort of young IDA patients, and evaluate factors predicting significant SB pathology.This was a retrospective, multicentre study (2010-2015) in consecutive, young patients (?50 years) from 18 centres/12 countries, with negative bidirectional gastrointestinal (GI) endoscopy undergoing SBCE for IDA. Exclusion criteria: previous/ongoing obscure-overt GI bleeding; age <19 or >50 years; comorbidities associated with IDA. Data retrieved: SBCE indications; prior investigations; medications; SBCE findings; final diagnosis. Clinical and laboratory data were analysed by multivariate logistic regression.Data on 389 young IDA patients were retrieved. In total, 169 (43.4%) were excluded due to incomplete clinical data; data from 220 (122F/98M; mean age 40.5?±?8.6 years) patients were analysed. Some 71 patients had at least one clinically significant SBCE finding (DY: 32.3%). They were divided into two groups: neoplastic pathology (10/220; 4.5%), and non-neoplastic but clinically significant pathology (61/220; 27.7%). The most common significant but non-neoplastic pathologies were angioectasias (22/61) and Crohn's disease (15/61). On multivariate analysis, weight loss and lower mean corpuscular volume(MCV) were associated with significant SB pathology (OR: 3.87; 95%CI: 1.3-11.3; p?=?0.01; and OR: 0.96; 95%CI: 0.92-0.99; p?=?0.03; respectively). Our model also demonstrates association between use of antiplatelets and significant SB pathology, although due to the small number of patients, definitive conclusions cannot be drawn.In IDA patients ?50 years with negative bidirectional GI endoscopy, overall DY of SBCE for clinically significant findings was 32.3%. Some 5% of our cohort was diagnosed with SB neoplasia; lower MCV or weight loss were associated with higher DY for SB pathology.

SUBMITTER: Yung DE

PROVIDER: S-EPMC5676544 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.

Yung Diana E DE Rondonotti Emanuele E Giannakou Andry A Avni Tomer T Rosa Bruno B Toth Ervin E Lucendo Alfredo J AJ Sidhu Reena R Beaumont Hanneke H Ellul Pierre P Negreanu Lucian L Jiménez-Garcia Victoria Alejandra VA McNamara Deidre D Kopylov Uri U Elli Luca L Triantafyllou Konstantinos K Shibli Fahmi F Riccioni Maria Elena ME Bruno Mauro M Dray Xavier X Plevris John N JN Koulaouzidis A A Argüelles-Arias Federico F Becq Aymeric A Branchi Federica F Tejero-Bustos María Ángeles MÁ Cotter Jose J Eliakim Rami R Ferretti Francesca F Gralnek Ian M IM Herrerias-Gutierrez Juan Manuel JM Hussey Mary M Jacobs Maarten M Johansson Gabriele Wurm GW McAlindon Mark M Montiero Sara S Nemeth Artur A Pennazio Marco M Rattehalli Deepa D Stemate Ana A Tortora Annalisa A Tziatzios Georgios G

United European gastroenterology journal 20170201 7

<h4>Background</h4>Recent data imply young patients (age ≤50 years) undergoing small-bowel (SB) capsule endoscopy (CE) for iron deficiency anaemia (IDA) show higher diagnostic yield (DY) for sinister pathology. We aimed to investigate DY of CE in a large cohort of young IDA patients, and evaluate factors predicting significant SB pathology.<h4>Materials and methods</h4>This was a retrospective, multicentre study (2010-2015) in consecutive, young patients (≤50 years) from 18 centres/12 countries, ...[more]

PMID: 29163963

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Project description:BackgroundVideo capsule endoscopy (VCE) is a commonly used test for the evaluation of obscure gastrointestinal bleeding. However, long-term outcomes of patients undergoing VCE are unclear.AimsTo evaluate the long-term outcomes in patients undergoing VCE for suspected obscure bleeding including iron deficiency anemia (IDA), and determine the need for additional intervention for persistence or recurrence of symptoms in patients with a diagnostic as well as non-diagnostic VCE.DesignRetrospective cohort study within a large county hospital system.MethodsWe collected information on indications and findings of VCE and outcomes including further testing, bleeding, and hemoglobin (Hgb) at last follow-up through structured review of the electronic health records. VCE findings were classified as active bleeding or high potential for bleeding (P2), intermediate potential (P1) or without any disruption of the mucosa, and no potential for bleeding (P0). We compared demographic and clinical characteristics between patients with and without normal Hgb at the time of last follow up.ResultsWe examined 116 patients who underwent VCEs performed for obscure gastrointestinal (GI) bleeding during 2010 to 2012 with mean duration of follow up after VCE completion of 571 days (standard deviation [SD]?=?248). Abnormal VCE findings (37.9% for P1 lesions, 44.8% for P2 lesions) were seen in 106 (87.9%) patients. Additional diagnostic testing was performed in 55/116 (47.4%) (67.7% GI procedures). Hgb was restored to normal range in 59/116 (50.9%) by end of follow up which were attributed to iron supplementation and/or discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs) in a majority. Twenty six of 116 patients experienced rebleeding (22.4%).ConclusionsThe diagnostic yield of VCE is high among patients with obscure GI bleeding. More than 50% of patients achieve normal Hgb in the long term with conservative measures such as iron supplementation and the discontinuation of NSAIDs.

Dataset Information

Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.

Publications

Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.

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