Capsule endoscopy for obscure gastrointestinal bleeding in patients with comorbid rheumatic diseases.

Neal Shahidi,Jessica Tong,Cherry Galorport,Robert Enns,George Ou,Joanna K Law,Ricky Kwok

doi:10.1155/2014/534345

Abstract

Background and Aim. We evaluated the association between patients with rheumatic diseases (RD) suffering from obscure gastrointestinal bleeding (OGIB) and positive capsule endoscopy (CE) findings. Methods. All CE procedures performed on patients with RD and OGIB were assessed from a large database at St. Paul's Hospital (Vancouver, BC, Canada) between December 2001 and April 2011. A positive finding on CE was defined as any pathology, including ulcers/erosions, vascular lesions, and mass lesions, perceived to be the source of bleeding. Results. Of the 1133 CEs performed, 41 (4%) complete CEs were for OGIB in patients with RD. Of these, 54% presented with overt bleeding. Mean age was 66 years. Positive findings were seen in 61% of patients. Ulcerations/erosions (36%) and vascular lesions (36%) were the most common findings. Significant differences between the RD versus non-RD populations included: inpatient status, nonsteroidal anti-inflammatory drug (NSAIDs) use, oral steroid use, and mean Charlson index score (all P ≤ 0.008). Similar nonsignificant trends were seen between positive and negative CEs among the RD population. Conclusions. The correlation between RD and positive CE findings is likely influenced by ongoing anti-inflammatory drug use, poorer health status, and a predisposition for angiodysplastic lesions.

Highlights

Capsule endoscopy (CE) is a novel diagnostic technique which allows assessment of the entire small bowel that is not feasible with conventional endoscopy
Our study shows that the correlation between rheumatic diseases (RD) and positive capsule endoscopy (CE) findings is influenced in a multifactorial manner; ongoing anti-inflammatory drug use, overall poorer health status, and a predisposition to vascular lesions may be pivotal factors driving this association
As highlighted in our study, a potentially significant contributing factor for the correlation between RD and positive CE findings is the ongoing utilization of nonsteroidal anti-inflammatory drugs (NSAIDs)

Summary

Introduction

Capsule endoscopy (CE) is a novel diagnostic technique which allows assessment of the entire small bowel that is not feasible with conventional endoscopy. With the emergence of CE as a pivotal tool in current investigational algorithms for OGIB, consequent studies [1, 8,9,10,11] have attempted to identify predictors of positive findings on CE with the goal of refining patient selection to optimize diagnostic yield. In a recent study assessing this correlation, we identified comorbid rheumatic diseases (RD) as a significant correlate to positive findings on CE [11]. We evaluated the association between patients with rheumatic diseases (RD) suffering from obscure gastrointestinal bleeding (OGIB) and positive capsule endoscopy (CE) findings. A positive finding on CE was defined as any pathology, including ulcers/erosions, vascular lesions, and mass lesions, perceived to be the source of bleeding. The correlation between RD and positive CE findings is likely influenced by ongoing anti-inflammatory drug use, poorer health status, and a predisposition for angiodysplastic lesions

Methods

Results

Conclusion