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

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.

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