title: The use of small-bowel capsule endoscopy in iron-deficiency anemia alone; be aware of the young anemic patient.
abstract: OBJECTIVE
  The role of Small-Bowel Capsule Endoscopy (SBCE) in Iron Deficiency Anemia (IDA) alone is still under validation. We aim to assess the usefulness of SBCE in patients with IDA alone.
  
  
  METHODS
  Retrospective study; patients with IDA (no GI symptoms or known previous diagnosis), who underwent SBCE were included. SBCE findings were classified as clinically significant/sinister (small-bowel malignancy, significant/sinister inflammation and/or strictures and coeliac disease) or vascular, i.e., signifcant/angioectasias (P1/P2 lesions).
  
  
  RESULTS
  A total of 221 (151F/70M) patients had SBCE for IDA as the sole indication. The diagnostic yield (DY) was 30.7% (68/221). The DY for significant/sinister pathology and significant/angioectasias was 9% and 21.7%, respectively. In those ≤ 40 years (20; 13F/7M), significant pathology was found in 25% (5/20); in the >40-year group (201; 138F/63M), significant/sinister pathology was found in 7.5% (15/201), p = 0.0231. None of the patients ≤40 years had angioectasias, such lesions were found in 48/201 (21.7%) of those >40 years, p = 0.009. Fifty percent of those >80 years (16; 12F/4M) had angioectasias, but none had significant/sinister pathology (p = 0.0126). On multiple regression analysis, only prior blood transfusion was predictive of higher DY in SBCE.
  
  
  CONCLUSIONS
  IDA alone is one of the main indications (27%) for referral to SBCE; the majority of patients are >40 years. In our cohort, the DY of SBCE for IDA was 30.7% and the commonest finding was angioectasias. The detection rate of sinister small-bowel pathology for those >40 years is low decreasing to zero in the >80 age group. In contrast, 25% of those ≤40 years had a sinister diagnosis.
authors.affiliation: Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK. akoulaouzidis@hotmail.com
authors.forename: Anastasios
authors.initials: A
authors.lastname: Koulaouzidis
authors.forename: Diana E
authors.initials: DE
authors.lastname: Yung
authors.forename: Jeff H P
authors.initials: JH
authors.lastname: Lam
authors.forename: Alexandros
authors.initials: A
authors.lastname: Smirnidis
authors.forename: Sarah
authors.initials: S
authors.lastname: Douglas
authors.forename: John N
authors.initials: JN
authors.lastname: Plevris
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000209:etiology*; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis; D004751:Enteritis / Q000150:complications / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications / Q000175:diagnosis*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013684:Telangiectasis / Q000150:complications / Q000175:diagnosis