title: Capsule endoscopy for obscure gastrointestinal bleeding in the tropics: report from India.
abstract: BACKGROUND
  Capsule endoscopy (CE) is useful in patients with obscure gastrointestinal bleeding (OGIB). Experience in CE in OGIB in the tropics is limited.
  
  
  METHODS
  Eighty-six patients with OGIB were evaluated clinically and using CE (Given Imaging, Yoqneam, Israel) 89 times (twice in three patients) during a 64-month period. Images were downloaded and examined by a single investigator using software (Rapid Reader; Given Imaging, Yoqneam, Israel). Patients received specific treatment and were followed up. Intraoperative findings, response to specific treatment and outcome on follow up (10.3±14.1 months) were considered to confirm CE findings.
  
  
  RESULTS
  Of 86 patients (aged 54.5±16.3 years, 63 males), 64 and 22 had OGIB-overt and OGIB-occult, respectively. Lesions were equally detected in OGIB-overt and OGIB-occult patients (48/64, 75% vs 18/22, 81.8%, P= ns). Lesions were detected in 64 of 86 (74.4%) patients [vascular malformations with or without fresh bleeding in 24 (37.5%), tumors in 12 (18.8%), strictures in 15 (23.4%), ulcers in five (7.8%), hookworm in five (7.8%), and more than one lesion in three patients (4.7%)]. Endoscopic insertion of the capsule was required in four patients, and in six it was retained, although none developed intestinal obstruction (surgical removal in two). The sensitivity, specificity, positive and negative predictive values of CE to detect the lesion(s) were 92.9%, 68.2%, 84.8%, and 83.3%, respectively.
  
  
  CONCLUSIONS
  CE is safe and is equally effective in detecting lesion(s) in occult and overt OGIB. Worm infestation and small bowel tuberculosis are unique and important causes of OGIB in the tropics.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. udayghoshal@gmail.com
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Chandrasekharan P
authors.initials: CP
authors.lastname: Lakshmi
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Kshaunish
authors.initials: K
authors.lastname: Das
authors.forename: Asha
authors.initials: A
authors.lastname: Misra
authors.forename: Praveer
authors.initials: P
authors.lastname: Rai
authors.forename: Samir
authors.initials: S
authors.lastname: Mohindra
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Saraswat
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Gourdas
authors.initials: G
authors.lastname: Choudhuri
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity