title: High diagnostic and clinical impact of small-bowel capsule endoscopy in patients with hereditary hemorrhagic telangiectasia with overt digestive bleeding and/or severe anemia.
abstract: BACKGROUND
  Patients with hereditary hemorrhagic telangiectasia (HHT) often present with recurrent anemia because of epistaxis or GI bleeding in relation to telangiectases mostly located in the stomach or small bowel. Capsule endoscopy is considered a major diagnostic tool for small-bowel diseases, but the impact of capsule endoscopy imaging on patient management in HHT is poorly understood.
  
  
  OBJECTIVE
  To clarify the contribution of capsule endoscopy in selected patients with HHT.
  
  
  METHODS
  Prospective, descriptive study.
  
  
  METHODS
  Multicenter, two university hospital tertiary-care centers, from January 2003 to June 2007.
  
  
  METHODS
  This study involved 30 patients with HHT and severe anemia (hemoglobin <9 g/dL; normal: 11-15 g/dL) and minimal epistaxis or moderate anemia but overt GI bleeding.
  
  
  METHODS
  Capsule endoscopy investigation.
  
  
  METHODS
  Clinical characteristics and capsule endoscopy results and their clinical consequences.
  
  
  RESULTS
  Capsule endoscopy detected gastric and small-bowel telangiectases in 14 (46.7%) and 26 (86.7%) cases, respectively. Active bleeding was present in 36.7% of cases. Diffuse telangiectases were detected in 42.3% without correlation with age, sex, or type of HHT mutation. Further investigations were carried out as a consequence of the capsule endoscopy results in 67% of cases. Treatment, consisting mostly of endoscopic argon plasma coagulation, was scheduled in 46.7% of patients.
  
  
  CONCLUSIONS
  Our population was essentially composed of patients with the ALK1 mutation.
  
  
  CONCLUSIONS
  This study shows that there is a high diagnostic yield for capsule endoscopy in selected patients with HHT. Capsule endoscopy makes possible precise mapping of lesions and has a considerable impact on the management of these selected patients by using a predefined algorithm: a limited number of accessible lesions is suitable for endoscopic treatment, whereas innumerable diffuse lesions require a medical approach. We suggest that capsule endoscopy could be a first-line, noninvasive, digestive tract examination in selected patients with HHT.
authors.affiliation: Service de gastroentérologie et d'hépatologie, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Grève
authors.forename: Driffa
authors.initials: D
authors.lastname: Moussata
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Gaudin
authors.forename: Marie-Georges
authors.initials: MG
authors.lastname: Lapalus
authors.forename: Sophie
authors.initials: S
authors.lastname: Giraud
authors.forename: Sophie
authors.initials: S
authors.lastname: Dupuis-Girod
authors.forename: Alain
authors.initials: A
authors.lastname: Calender
authors.forename: Henri
authors.initials: H
authors.lastname: Plauchu
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
mesh_terms: D030301:Activin Receptors, Type II / Q000235:genetics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis*; D053704:Capsule Endoscopy; D003937:Diagnosis, Differential; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005838:Genotype; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000235:genetics; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis* / Q000235:genetics
chemical_list: C425364:ACVRL1 protein, human; D030301:Activin Receptors, Type II