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.

Yung, D., Rondonotti, E., Giannakou, A., Avni, T., Rosa, B., Toth, E., Lucendo, A., Sidhu, R., Beaumont, H., Ellul, P., Negreanu, L., Jimenez-garcia, V., Mcnamara, D., Kopylov, U., Elli, L., Triantafyllou, K., Shibli, F., Riccioni, M., Bruno, M., Dray, X., Plevris, J., Koulaouzidis, A., Arguelles-arias, F., Becq, A., Branchi, F., Tejero-bustos, M., Cotter, J., Eliakim, R., Ferretti, F., Gralnek, I., Herrerias-gutierrez, J., Hussey, M., Jacobs, M., Johansson, G., Mcalindon, M., Montiero, S., Nemeth, A., Pennazio, M., Rattehalli, D., Stemate, A., Tortora, A., Tziatzios, G., Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy, <<UNITED EUROPEAN GASTROENTEROLOGY JOURNAL>>, 2017; 5 (7): 974-981. [doi:10.1177/2050640617692501] [http://hdl.handle.net/10807/170453]

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

Riccioni, Me;Ferretti, F;Tortora, A;
2017

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.
Inglese
Yung, D., Rondonotti, E., Giannakou, A., Avni, T., Rosa, B., Toth, E., Lucendo, A., Sidhu, R., Beaumont, H., Ellul, P., Negreanu, L., Jimenez-garcia, V., Mcnamara, D., Kopylov, U., Elli, L., Triantafyllou, K., Shibli, F., Riccioni, M., Bruno, M., Dray, X., Plevris, J., Koulaouzidis, A., Arguelles-arias, F., Becq, A., Branchi, F., Tejero-bustos, M., Cotter, J., Eliakim, R., Ferretti, F., Gralnek, I., Herrerias-gutierrez, J., Hussey, M., Jacobs, M., Johansson, G., Mcalindon, M., Montiero, S., Nemeth, A., Pennazio, M., Rattehalli, D., Stemate, A., Tortora, A., Tziatzios, G., Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy, <<UNITED EUROPEAN GASTROENTEROLOGY JOURNAL>>, 2017; 5 (7): 974-981. [doi:10.1177/2050640617692501] [http://hdl.handle.net/10807/170453]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/170453
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