Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?

Riccioni, Maria Elena; Urgesi, Riccardo; Spada, Cristiano; Cianci, Rossella; Pelecca, Giorgio; Bizzotto, Alessandra; Costamagna, Guido

doi:10.1016/j.dld.2010.01.023

« Previous Next »Digestive and Liver Disease
Volume 42, Issue 8 , Pages 560-566, August 2010

Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?

Maria Elena Riccioni
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy
Riccardo Urgesi
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy
- Cattedra di Alimentazione e Nutrizione Umana, Dipartimento di Neuroscienze, Tor Vergata University, Rome, Italy
- Corresponding author at: Digestive Endoscopy Unit, Catholic University of Rome, Largo A. Gemelli, 8, 00168 Rome, Italy. Tel.: +39 06 30156580; fax: +39 06 30156581.
Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy
Rossella Cianci
- Institute of Internal Medicine, Catholic University of Rome, Rome, Italy
Giorgio Pelecca
- Gastroenterology Unit, Viterbo, Italy
Alessandra Bizzotto
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy
Guido Costamagna
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy

Received 17 November 2009; accepted 29 January 2010. published online 15 March 2010.

Abstract

Background

In around 30% of iron deficiency anaemia (IDA) cases a definite diagnosis cannot be made.

Aim

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%.