title: [Capsule endoscopy and obscure gastrointestinal bleeding: does the form of presentation matter?].
abstract: BACKGROUND
  Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract with no obvious cause after assessment with upper and lower gastrointestinal endoscopy. In these cases, the source is suspected to be in the small bowel. Obscure bleeding can be occult or overt. The aim of this study was to analyze the clinical and analytical characteristics and findings on capsule endoscopy in patients with OGIB and to determine the factors related to the detection of lesions in both forms of presentation.
  
  
  METHODS
  We performed a retrospective study of capsule endoscopies carried out between November 2009 and November 2012 for OGIB.
  
  
  RESULTS
  We analyzed 284 capsule endoscopies in 272 patients. Initially, 12 procedures could not be evaluated and were repeated. A total of 272 procedures were finally included in the analysis. The results of 114 (41.9%) capsule endoscopies were normal. Compared with patients with occult OGIB, those with overt OGIB were significantly older (70.2 vs. 67.5 years; p = 0.04), consumed more NSAID (24.2% vs. 11.9%; p = 0.01), had higher hemoglobin levels (9.3 vs. 10.4; p < 0,001) and more frequently required transfusion (64.5% vs 32.2%; p < 0.001). No differences were found between the two forms of presentation in the detection of canker sores-ulcers and polyps-masses. Vascular lesions were more frequently detected in overt than in occult OGIB (40.3% vs. 25.7%, respectively), (p < 0.05). When the total number of diagnoses carried out by capsule endoscopy was analyzed, no differences were found in diagnostic yield between overt OGIB (57%) and occult OGIB (54%), (p = 0.6). In overt OGIB, multivariate analysis showed that the variables that significantly predicted the detection of lesions on capsule endoscopy were consumption of medication NSAID (OR 2.75; p = 0.01), antiplatelets and anticoagulants (OR 2.64; p = 0.03) and analytical data hemoglobin (OR 3.23; p < 0.001) and INR (OR 1.8; p = 0.02). In occult OGIB, multivariate analysis showed that the factors significantly related to the detection of lesions on endoscopy were age (OR 1.9; p = 0.04) and NSAID consumption (OR 2.1; p = 0.01).
  
  
  CONCLUSIONS
  Capsule endoscopy is essential in the assessment of OGIB. Although the diagnostic yield was similar in both forms of presentation, vascular lesions were more frequently detected in overt OGIB. The diagnostic yield of capsule endoscopy could be optimized by taking into account the form of presentation (overt vs. occult) and certain clinical and analytic data (age, drug consumption, hemoglobin).
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España. Electronic address: martinez.gonzalez.javier@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Martínez-González
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Téllez Villajos
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Aicart-Ramos
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Crespo Pérez
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Graus Morales
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Boixeda de Miguel
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos Martínez
mesh_terms: D000368:Aged; D016888:Angiodysplasia / Q000150:complications / Q000000981:diagnostic imaging; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D001803:Blood Transfusion; D053704:Capsule Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors
keywords: Capsule endoscopy; Cápsula endoscópica; Hemorragia digestiva de origen oscuro; Intestino delgado; Manifiesta; Obscure gastrointestinal bleeding; Occult; Oculta; Overt; Small bowel