Role of small bowel investigation in iron deficiency anaemia after negative endoscopic/histologic evaluation of the upper and lower gastrointestinal tract.
BACKGROUND
The usefulness of small bowel investigation in iron deficiency anaemia (IDA) patients is controversial.


OBJECTIVE
To evaluate the presence of small bowel lesions likely to cause IDA in patients with unexplained IDA after negative gastroscopy with biopsies and colonoscopy (CS).


METHODS
A total of 117 outpatients, referred for unexplained IDA, underwent gastroscopy with biopsies and colonscopy. In 17 (14.5%) patients, endoscopic/histological investigations were negative. Of these patients, 13 underwent small bowel follow-through (SBFT) and if necessary to confirm the diagnosis, further gastrointestinal (GI) investigations.


RESULTS
Small bowel lesions likely to cause IDA were found in five (38%) patients. Four of these lesions were detected by SBFT, two of them were malignant. These findings, confirmed at surgery and ileoscopy (IS), led to the final diagnoses ofjejunal and ileal adenocarcinoma, idiopathic ileal ulcers and ileal Crohn's disease. In one case, after negative SBFT, jejunal angiodysplasia was detected by video capsule endoscopy (VCE). Faecal occult blood test (FOBT) was positive in four (31%) patients, all of whom presented lesions likely to cause IDA, detected in three cases by SBFT and in one case by VCE.


CONCLUSIONS
This study shows the importance of investigating the small bowel in IDA patients after negative upper and lower GI endoscopy, particularly if FOBT is positive.
Annibale
B
B
S. Andrea Hospital, La Sapienza University, Via di Grottarossa 1035, 00189 Rome, Italy. bruno.annibale@uniroma1.it
Capurso
G
G
Baccini
F
F
Lahner
E
E
D'Ambra
G
G
Di Giulio
E
E
Delle Fave
G
G
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis; D001706:Biopsy; D002214:Capsules; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis; D007078:Ileal Neoplasms / Q000150:complications / Q000175:diagnosis; D007421:Intestine, Small / Q000473:pathology*; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis; D007580:Jejunal Neoplasms / Q000150:complications / Q000175:diagnosis; D007583:Jejunum / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D014456:Ulcer / Q000150:complications / Q000175:diagnosis; D014741:Video Recording / Q000295:instrumentation
D002214:Capsules