Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2016; 22(38): 8568-8575
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8568
Uncovering the uncertainty: Risk factors and clinical relevance of P1 lesions on small bowel capsule endoscopy of anemic patients
Tiago Cúrdia Gonçalves, Mara Barbosa, Bruno Rosa, Maria João Moreira, José Cotter
Tiago Cúrdia Gonçalves, Mara Barbosa, Bruno Rosa, Maria João Moreira, José Cotter, Gastroenterology Department, Hospital da Senhora da Oliveira, 4835-044 Creixomil, Guimarães, Portugal
José Cotter, School of Health Sciences, University of Minho, 4710-057 Braga, Guimarães, Portugal
José Cotter, ICVS/3B’s, PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
Author contributions: Cúrdia Gonçalves T carried out the study, data collection and analysis, did the literature research and drafted the manuscript; Barbosa M participated in the design of the study and data collection; Rosa B and Moreira MJ participated in the design of the study and revised the manuscript; Cotter J critically revised the manuscript and approved the final version to be submitted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tiago Cúrdia Gonçalves, MD, Gastroenterology Department, Hospital da Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Creixomil, Guimarães, Portugal. tiagogoncalves@chaa.min-saude.pt
Telephone: +351-917503516 Fax: +351-253513592
Received: June 20, 2016
Peer-review started: June 21, 2016
First decision: July 29, 2016
Revised: August 2, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: October 14, 2016
Processing time: 114 Days and 10.4 Hours
Abstract
AIM

To identify risk factors for P1 lesions on small bowel capsule endoscopy (SBCE) and to describe the natural history of anemic patients with such type of lesions.

METHODS

One hundred patients were consecutively selected for a case-control analysis performed between 37 cases with P1 lesions and 63 controls with negative SBCE. Age, gender, comorbidities and regular medication were collected. Rebleeding, further investigational studies and death were also analyzed during the follow-up.

RESULTS

No significant differences on gender, median age or Charlson index were found between groups. Although no differences were found on the use of proton pump inhibitors, acetylsalicylic acid, anticoagulants or antiplatelet agents, the use of non-steroidal anti-inflammatory drugs (NSAID) was associated with a higher risk of P1 lesions (OR = 12.00, 95%CI: 1.38-104.1). From the 87 patients followed at our center, 39 were submitted to additional studies for investigation of iron-deficiency anemia (IDA), and this was significantly more common in those patients with no findings on SBCE (53.7% vs 30.3%, P = 0.033). A total of 29 patients had at least one rebleeding or IDA recurrence episode and 9 patients died of non-anemia related causes but no differences were found between cases and controls.

CONCLUSION

P1 lesions are commonly found in patients with IDA submitted to SBCE. The use of NSAID seems to be a risk factor for P1 lesions. The outcomes of patients with P1 lesions do not differ significantly from those with P0 lesions or normal SBCE.

Keywords: P1 lesions; Iron-deficiency anemia; Small bowel capsule endoscopy; Risk factors; Rebleeding

Core tip: Despite the high diagnostic yield of small bowel capsule endoscopy (SBCE) in the study of iron-deficiency anemia (IDA), the clinical relevance and bleeding potential of findings such as red spots or mucosal erosions (P1 lesions) remain uncertain. We found that P1 lesions were commonly found in the SBCE of patients with IDA and their presence was associated with non-steroidal anti-inflammatory drugs use. The outcomes of patients with P1 lesions do not differ significantly from those with P0 lesions or normal SBCE. An algorithm with a stepwise approach to the patients with IDA who are submitted to SBCE is proposed.