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

Yung, Diana E; Rondonotti, Emanuele; Giannakou, Andry; Avni, Tomer; Rosa, Bruno; Toth, Ervin; Lucendo, Alfredo J; Sidhu, Reena; Beaumont, Hanneke; Ellul, Pierre; Negreanu, Lucian; Jiménez-Garcia, Victoria Alejandra; McNamara, Deidre; Kopylov, Uri; Elli, Luca; Triantafyllou, Konstantinos; Shibli, Fahmi; Riccioni, Maria Elena; Bruno, Mauro; Dray, Xavier; Plevris, John N; Koulaouzidis, A; Argüelles-Arias, Federico; Becq, Aymeric; Branchi, Federica; Tejero-Bustos, María Ángeles; Cotter, Jose; Eliakim, Rami; Ferretti, Francesca; Gralnek, Ian M; Herrerias-Gutierrez, Juan Manuel; Hussey, Mary; Jacobs, Maarten; Johansson, Gabriele Wurm; McAlindon, Mark; Montiero, Sara; Nemeth, Artur; Pennazio, Marco; Rattehalli, Deepa; Stemate, Ana; Tortora, Annalisa; Tziatzios, Georgios

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.