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Abstract
BackgroundSmall bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Although angioectasia is the common etiology of SB bleeding, nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are also reported as a major cause in studies from Eastern countries. Herein, we assessed the frequency of occurrence of NSAID-induced SB lesions in Korean patients with obscure GI bleeding.MethodsWe retrospectively analyzed medical records of all consecutive patients aged ≥18 years who underwent capsule endoscopy from March 2018 to February 2019 at Ulsan University Hospital and Kosin University Gospel Hospital.ResultsOf the 83 subjects (all Korean; mean age ± standard deviation: 59 ± 18 years; age range: 18–84 years; men: n = 52; women: n = 31), 55 (66.2%) had stool with clear blood and 28 (33.8%) had normal stool with iron deficiency anemia. The detection rate of SB bleeding and lesions using capsule endoscopy was 72.3% (60 of 83 patients). A significantly higher frequency (40 of 51) of ulcerative/erosive lesions than other causes was observed in patients with inactive bleeding but visible SB lesions. As a result, NSAID-induced enteropathy accounted for 30.1% of 83 patients with obscure GI bleeding (25 of the all 60 SB bleeding cases).ConclusionsContrary to what is reported for patients in Western countries, this study in Korean patients showed an improved diagnostic yield of capsule endoscopy for obscure GI bleeding and that NSAID-induced enteropathy was the most common etiology of SB bleeding. Aggressive small intestine examination is required for patients with unexplained GI bleeding.
Highlights
Small bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases
Whereas angioectasia is the most common etiology of SB bleeding in Western countries [4, 7, 8], nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are the major cause reported in Japanese studies [9, 10]
Of the 37 patients, 33 had SB lesions; of these, 25 patients were diagnosed with NSAID-induced enteropathy without any other cause of SB bleeding
Summary
Small bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Angioectasia is the common etiology of SB bleeding, nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are reported as a major cause in studies from Eastern countries. We assessed the frequency of occurrence of NSAID-induced SB lesions in Korean patients with obscure GI bleeding. Whereas angioectasia is the most common etiology of SB bleeding in Western countries [4, 7, 8], nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are the major cause reported in Japanese studies [9, 10]. We aimed to assess the frequency of NSAID-induced SB lesions in Korean patients with obscure GI bleeding, who underwent capsule endoscopy
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