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

Autor: Yung DE; Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK., Rondonotti E; Gastroenterology Unit, Valduce Hospital, Como, Italy., Giannakou A; Faculty of Economics and Management, The Open University of Cyprus, Nicosia, Cyprus., Avni T; Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Rosa B; Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal., Toth E; Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden., Lucendo AJ; Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain., Sidhu R; Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom., Beaumont H; Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands., Ellul P; Division of Gastroenterology, Mater Dei Hospital, Malta., Negreanu L; Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest., Jiménez-Garcia VA; University Hospital Virgen Macarena, Seville, Spain., McNamara D; Department of Clinical Medicine, Trinity College Dublin, Ireland., Kopylov U; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel., Elli L; Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy., Triantafyllou K; Hepatogastroenterology 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., Shibli F; Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel., Riccioni ME; Catholic University of the Sacred Heart, Milano, Italy., Bruno M; Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy., Dray X; Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France., Plevris JN; Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK., Koulaouzidis A; Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK., Argüelles-Arias F; University Hospital Virgen Macarena, Seville, Spain., Becq A; Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France., Branchi F; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy., Tejero-Bustos MÁ; Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain., Cotter J; Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal., Eliakim R; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel., Ferretti F; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy., Gralnek IM; Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel.; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Herrerias-Gutierrez JM; University Hospital Virgen Macarena, Seville, Spain., Hussey M; Department of Clinical Medicine, Trinity College Dublin, Ireland., Jacobs M; Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands., Johansson GW; Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden., McAlindon M; Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom., Montiero S; Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal., Nemeth A; Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden., Pennazio M; Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy., Rattehalli D; Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom., Stemate A; Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest., Tortora A; Catholic University of the Sacred Heart, Milano, Italy., Tziatzios G; Hepatogastroenterology 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.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2017 Nov; Vol. 5 (7), pp. 974-981. Date of Electronic Publication: 2017 Feb 01.
DOI: 10.1177/2050640617692501
Abstrakt: 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.
Databáze: MEDLINE
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