Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?
BACKGROUND
In around 30% of iron deficiency anaemia (IDA) cases a definite diagnosis cannot be made.


OBJECTIVE
To investigate the role of capsule endoscopy (CE) in detecting lesions in patients with unexplained IDA after a negative endoscopic, serologic and haematologic diagnostic work up and its possible role in influencing clinical outcome.


METHODS
138 patients suffering from IDA were identified among 650 consecutive patients undergoing CE at our unit.


RESULTS
CE revealed the following positive findings in 91/138 patients: angiodysplasias in 51 patients; jejunal and/or ileal micro-ulcerations in 12; tumours/polyps in 9; erosive gastritis in 4; Crohn's disease in 5; jejunal villous atrophy in 5; a solitary ileal ulcer in 1 and active bleeding in the last 4 patients. Follow up data were available for 80/91 patients (87.9%). In 15 out of 46 patients with angiodysplasias IDA spontaneously resolved without any treatment; 9 patients required iron supplementation; 10 patients healed after lanreotide administration; APC was performed in 9 out of 46 patients and 3 patients underwent regular blood transfusion without any success on IDA. 10 out of the 12 patients with small bowel micro-ulcers spontaneously recovered from IDA whilst 2 patients after iron supplementation. All 9 patients affected by tumours/polyps were surgically addressed. In all erosive gastritis cases, patients recovered from IDA after PPI and Helicobacter pylori eradication. Four patients with Crohn's disease diagnosis restored to health with medical therapy. One out of the 4 patients with jejunal villous atrophy and the sole patient with a solitary ileal ulcer spontaneously healed. In 1 out of 3 patients with active bleeding IDA resolved without further treatment after blood transfusion whilst 2 patients were referred for surgical treatment. At follow up, complete resolution of IDA was achieved in 96.25%.


CONCLUSIONS
Small bowel investigation is a matter of great importance in IDA patients after negative upper and lower gastrointestinal endoscopy.
Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy.
Maria Elena
ME
Riccioni
Riccardo
R
Urgesi
Cristiano
C
Spada
Rossella
R
Cianci
Giorgio
G
Pelecca
Alessandra
A
Bizzotto
Guido
G
Costamagna
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D016888:Angiodysplasia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D053705:Capsule Endoscopes; D002648:Child; D003424:Crohn Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D016145:Endoscopy, Digestive System / Q000295:instrumentation; D005260:Female; D005756:Gastritis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007414:Intestinal Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D007417:Intestinal Polyps / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult