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

Yung, Diana E.; Rondonotti, Emanuele; Giannakou, Andry; Avni, Tomer; Rosa, Bruno; Toth, Ervin LU ; Lucendo, Alfredo J.; Sidhu, Reena; Beaumont, Hanneke and Ellul, Pierre, et al. (2017) In United European Gastroenterology Journal 5(7). p.974-981
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... (More)

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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published
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keywords
Capsule endoscopy, iron deficiency anaemia, neoplasia, small bowel, young
in
United European Gastroenterology Journal
volume
5
issue
7
pages
8 pages
publisher
SAGE Publications Inc.
external identifiers
  • scopus:85032942077
  • wos:000414408600006
ISSN
2050-6406
DOI
10.1177/2050640617692501
language
English
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yes
id
06fc5f7b-4704-42a1-962d-3fdb3839c2ea
date added to LUP
2017-11-23 07:20:04
date last changed
2018-07-10 12:38:06
@article{06fc5f7b-4704-42a1-962d-3fdb3839c2ea,
  abstract     = {<p>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 &lt;19 or &gt;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.</p>},
  author       = {Yung, Diana E. and Rondonotti, Emanuele and Giannakou, Andry and Avni, Tomer and Rosa, Bruno and Toth, Ervin and Lucendo, Alfredo J. and Sidhu, Reena and Beaumont, Hanneke and Ellul, Pierre and Negreanu, Lucian and Jiménez-Garcia, Victoria Alejandra and McNamara, Deidre and Kopylov, Uri and Elli, Luca and Triantafyllou, Konstantinos and Shibli, Fahmi and Riccioni, Maria Elena and Bruno, Mauro and Dray, Xavier and Plevris, John N. and Koulaouzidis, A. and Argüelles-Arias, Federico and Becq, Aymeric and Branchi, Federica and Tejero-Bustos, María Ángeles and Cotter, Jose and Eliakim, Rami and Ferretti, Francesca and Gralnek, Ian M. and Herrerias-Gutierrez, Juan Manuel and Hussey, Mary and Jacobs, Maarten and Johansson, Gabriele Wurm and McAlindon, Mark and Montiero, Sara and Nemeth, Artur and Pennazio, Marco and Rattehalli, Deepa and Stemate, Ana and Tortora, Annalisa and Tziatzios, Georgios and , },
  issn         = {2050-6406},
  keyword      = {Capsule endoscopy,iron deficiency anaemia,neoplasia,small bowel,young},
  language     = {eng},
  month        = {11},
  number       = {7},
  pages        = {974--981},
  publisher    = {SAGE Publications Inc.},
  series       = {United European Gastroenterology Journal},
  title        = {Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy},
  url          = {http://dx.doi.org/10.1177/2050640617692501},
  volume       = {5},
  year         = {2017},
}