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

15 Fev. 2019 |

Diana E Yung,1 Emanuele Rondonotti,2 Andry Giannakou,3 Tomer Avni,4 Bruno Rosa,5 Ervin Toth,6 Alfredo J Lucendo,7,23 Reena Sidhu,8 Hanneke Beaumont,9 Pierre Ellul,10 Lucian Negreanu,11Victoria Alejandra Jiménez-Garcia,12 Deidre McNamara,13 Uri Kopylov,14 Luca Elli,15 Konstantinos Triantafyllou,16 Fahmi Shibli,17 Maria Elena Riccioni,18 Mauro Bruno,19 Xavier Dray,20 John N Plevris,1 A Koulaouzidis,1 And the Capsule Endoscopy in Young Patients with IDA research group, Federico Argüelles-Arias,12 Aymeric Becq,20 Federica Branchi,21 María Ángeles Tejero-Bustos,7 Jose Cotter,5 Rami Eliakim,14 Francesca Ferretti,21 Ian M Gralnek,17,22 Juan Manuel Herrerias-Gutierrez,12 Mary Hussey,13 Maarten Jacobs,9 Gabriele Wurm Johansson,6 Mark McAlindon,8 Sara Montiero,5 Artur Nemeth,6 Marco Pennazio,19 Deepa Rattehalli,8 Ana Stemate,11 Annalisa Tortora,18 and Georgios Tziatzios16

1Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
2Gastroenterology Unit, Valduce Hospital, Como, Italy
3Faculty of Economics and Management, The Open University of Cyprus, Nicosia, Cyprus
4Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
5Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
6Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
7Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain
8Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
9Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands
10Division of Gastroenterology, Mater Dei Hospital, Malta
11Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest
12University Hospital Virgen Macarena, Seville, Spain
13Department of Clinical Medicine, Trinity College Dublin, Ireland
14Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
15Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
16Hepatogastroenterology 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
17Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel
18Catholic University of the Sacred Heart, Milano, Italy
19Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
20Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France
21Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
22Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
23Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain


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.

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.

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