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Published on: August 26, 2014
Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal
Diana E Yung1, Emanuele Rondonotti2, Andry Giannakou3
1Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK.
Insights
Capsule endoscopy (CE) in young patients with iron deficiency anaemia (IDA) yields significant small bowel (SB) pathology in 32.3% of cases. Lower mean corpuscular volume (MCV) and weight loss predict higher diagnostic yield for SB disease.
Area of Science:
- Gastroenterology
- Endoscopy
- Oncology
Background:
- Young patients (≤50 years) with iron deficiency anaemia (IDA) often have higher diagnostic yield for sinister pathology via small bowel capsule endoscopy (SBCE).
- Previous bidirectional gastrointestinal (GI) endoscopy was negative in this cohort.
- This study evaluates the diagnostic yield (DY) of SBCE in young IDA patients and identifies predictors of significant small bowel (SB) pathology.
Purpose of the Study:
- To investigate the diagnostic yield (DY) of SBCE in a large cohort of young patients (≤50 years) with iron deficiency anaemia (IDA).
- To identify factors predicting significant small bowel (SB) pathology in this population.
Main Methods:
- Retrospective, multicentre study (2010-2015) involving 220 young IDA patients (≤50 years) with negative bidirectional GI endoscopy.
- Data on SBCE indications, prior investigations, medications, findings, and final diagnoses were retrieved.
- Multivariate logistic regression analysed clinical and laboratory data to identify predictors of significant SB pathology.
Main Results:
- A total of 220 patients were analyzed; 71 (32.3%) had clinically significant SBCE findings.
- Neoplastic pathology was diagnosed in 4.5% (10/220) and significant non-neoplastic pathology in 27.7% (61/220).
- Lower mean corpuscular volume (MCV) and weight loss were associated with significant SB pathology (OR: 0.96; p=0.03 and OR: 3.87; p=0.01, respectively).
Conclusions:
- SBCE demonstrated a 32.3% diagnostic yield for clinically significant findings in young IDA patients with negative bidirectional GI endoscopy.
- Approximately 5% of the cohort was diagnosed with small bowel neoplasia.
- Lower MCV and weight loss are associated with a higher diagnostic yield for SB pathology in this patient group.
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.
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