Abstract
Introduction: Small bowel gastrointestinal angiodysplasias (SBGIAD) are vascular lesions that account for 40% of obscure gastrointestinal bleeding cases and is a major cause of occult GI blood loss. SBGIAD and its relationship to racial disparities have not been extensively studied. We performed a retrospective review at a single center institution to examine the relationship between non-Hispanic white (nHw) and non-White veteran patients diagnosed with SBGIAD. Clinical outcomes (which included but were not restricted to transfusion and hospitalization rates), comorbidities, SBGIAD location as well as demographic characteristics were evaluated. Methods: Patients undergoing video capsule endoscopy (VCE) between 2006 and 2013 and diagnosed with SBGIAD were included in this study. Hospitalization was defined as any admission during a 6-month period after the first complete VCE. Re-bleeding was defined as a transfusion of 2 units of pRBC or more in a 1-year period after VCE evaluation. Demographic data, transfusion requirements, hospitalization rates, VCE findings and patient outcomes were analyzed from electronic charts. Analysis was done using X2 and independent samples t test. Results: 425 patients underwent VCE between 2006 and 2013 for obscure occult and obscure overt GI bleeds. 87 patients were diagnosed with SBGIAD on VCE, 47 patients were nHw compared to 40 patients who were non-White. Non-White patients with SBGIAD were 6.2 times more likely to be hospitalized within a 6-month period, compared to nHw patients (CI 0.032-0.800, p= 0.026). No difference was found based on the location of small bowel GIAD, transfusion rates, age and BMI between the two groups. Hyperlipidemia (HLD) was the only comorbid condition that had a significant association between the two groups. On multivariate analysis, nHw patients were 2.5 times more likely to have HLD than non Whites (CI 0.999- 0.295, p= 0.050). Conclusion: The odds of hospitalization were 6.2 times higher in non-White patients compared to nHw in our study. Also, nHw patients had 2.5 times higher odds of having hyperlipidemia compared to non-White patients with GIAD. No significant association between the two subgroups with respect to age, BMI, location of small bowel GIAD, transfusion rates, HTN, DM, CHF or CAD was found. Other factors (number of ER/ acute care visits) before hospitalization and understanding the impact of hyperlipidemia to explain the disparity in hospitalization rates for SBGIAD observed should be the focus of future invesitigation.Figure 1Figure 2
Published Version
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