The Spectrum of Small Intestinal Lesions in Patients with Unexplained Iron Deficiency Anemia Detected by Video Capsule Endoscopy

• Main Authors: Antonella Contaldo, Giuseppe Losurdo, Francesca Albano, Andrea Iannone, Michele Barone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi
• Format: Article
• Language: English
• Published: MDPI AG 2019-02-01
• Series: Medicina
• Subjects: anemia; videocapsule endoscopy; obscure occult bleeding; NSAIDs; PPIs
• Online Access: https://www.mdpi.com/1010-660X/55/3/59

<i>Background and objectives</i>: Video-capsule endoscopy (VCE) has shown a large range (38&#8315;83%) of diagnostic yield in unexplained iron deficiency anemia (IDA) and obscure-occult bleeding. Therefore, we retrospectively investigated the VCE-detected spectrum and the prevalence of small bowel injuries and associated risk factors in inpatients with both of the above reported conditions. <i>Methods</i>: We selected inpatients with IDA (hemoglobin &lt;12 g/dL in women, &lt;13 g/dL in men) and obscure-occult bleeding. We excluded VCE indications other than IDA. Complete medical histories and laboratory tests were collected. All subjects underwent PillCam SB2/SB3. The VCE feature Lewis score was calculated when appropriate. We used the <i>t</i>-test and Fisher&#8217;s exact test for continuous and categorical variables, respectively, in univariate analysis. For multivariate analysis, we used binomial logistic regression. <i>Results</i>: We retrieved 109 patients (female:male ratio of 53:56; age 63.4 &#177; 18.9 years). Eighty patients (73.4%) showed &#8805;1 small bowel lesions. The Lewis score was calculated in 41 patients: 13 (31.7%) showed a mild (&lt;135) and 28 (68.3%) a moderate-severe (135&#8315;790 and &gt;790, respectively) score. In univariate analysis, the small bowel transit time (6.2 &#177; 2.9 versus 5.2 &#177; 2.1 h; <i>p</i> = 0.049) and non-steroidal anti-inflammatory drug use for at least two weeks (17.5% versus 0%; <i>p</i> = 0.01) were significantly higher in subjects with injuries. These associations were not confirmed at multivariate analysis. The severity of a lesion directly correlated with proton pump inhibitor (PPI) use and duration (not confirmed in multivariate analysis). VCE can reveal the source of obscure-occult bleeding in a high percentage of unexplained IDAs. A wide spectrum of endoscopic pictures may be found. Known as well as supposed risk factors for small bowel lesions may be detected.