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Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?
Maria Elena Riccioni1, Riccardo Urgesi, Cristiano Spada
1Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy.
Summary
Capsule endoscopy (CE) is crucial for diagnosing unexplained iron deficiency anaemia (IDA) when other tests fail. CE identified small bowel lesions in most patients, leading to successful treatment and resolution of IDA in over 96%.
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
- Internal Medicine
Background:
- Approximately 30% of iron deficiency anaemia (IDA) cases lack a definitive diagnosis through standard methods.
- Unexplained IDA necessitates further investigation beyond conventional endoscopic, serologic, and hematologic workups.
Purpose of the Study:
- To evaluate the diagnostic yield of capsule endoscopy (CE) in patients with unexplained IDA.
- To assess the impact of CE findings on clinical outcomes and treatment strategies for IDA.
Main Methods:
- A cohort of 138 patients with IDA, identified from 650 consecutive CE procedures, was analyzed.
- Patients underwent capsule endoscopy after negative upper and lower gastrointestinal evaluations.
Main Results:
- Capsule endoscopy detected lesions in 91 out of 138 IDA patients, including angiodysplasias, micro-ulcerations, tumors/polyps, and Crohn's disease.
- Treatment guided by CE findings, such as surgery, iron supplementation, or PPI therapy, led to complete IDA resolution in 96.25% of cases.
- Specific findings like angiodysplasias and small bowel micro-ulcers showed high spontaneous resolution or recovery rates with minimal intervention.
Conclusions:
- Capsule endoscopy plays a vital role in diagnosing the source of bleeding in IDA patients with negative conventional endoscopic evaluations.
- Investigating the small bowel is essential for comprehensive IDA diagnosis and management.
- CE findings significantly influence clinical management and contribute to high rates of IDA resolution.
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