Diana E Yung1, Emanuele Rondonotti2, Andry Giannakou3, Tomer Avni4, Bruno Rosa5, Ervin Toth6, Alfredo J Lucendo7,8, Reena Sidhu9, Hanneke Beaumont10, Pierre Ellul11, Lucian Negreanu12, Victoria Alejandra Jiménez-Garcia13, Deidre McNamara14, Uri Kopylov15, Luca Elli16, Konstantinos Triantafyllou17, Fahmi Shibli18, Maria Elena Riccioni19, Mauro Bruno20, Xavier Dray21, John N Plevris1, A Koulaouzidis1, Federico Argüelles-Arias13, Aymeric Becq21, Federica Branchi22, María Ángeles Tejero-Bustos7, Jose Cotter5, Rami Eliakim15, Francesca Ferretti22, Ian M Gralnek18,23, Juan Manuel Herrerias-Gutierrez13, Mary Hussey14, Maarten Jacobs10, Gabriele Wurm Johansson6, Mark McAlindon9, Sara Montiero5, Artur Nemeth6, Marco Pennazio20, Deepa Rattehalli9, Ana Stemate12, Annalisa Tortora19, Georgios Tziatzios17. 1. Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK. 2. Gastroenterology Unit, Valduce Hospital, Como, Italy. 3. Faculty of Economics and Management, The Open University of Cyprus, Nicosia, Cyprus. 4. Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 5. Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal. 6. Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden. 7. Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain. 8. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain. 9. Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom. 10. Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands. 11. Division of Gastroenterology, Mater Dei Hospital, Malta. 12. Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest. 13. University Hospital Virgen Macarena, Seville, Spain. 14. Department of Clinical Medicine, Trinity College Dublin, Ireland. 15. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel. 16. Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 17. Hepatogastroenterology Unit, 2nd Dept of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece. 18. Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel. 19. Catholic University of the Sacred Heart, Milano, Italy. 20. Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy. 21. Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France. 22. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. 23. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Abstract
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Entities:
Keywords:
Capsule endoscopy; iron deficiency anaemia; neoplasia; small bowel; young
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