Small Bowel Angiodysplasias (SBAs) and Associated Medical Comorbidities, A Single Center Cohort Study Based on Small Bowel Capsule Endoscopy (SBCE)

Abstract

Purpose: Vascular abnormalities of the small bowel are the most common cause of obscure GI bleeding (OGIB). An association has been described with aortic stenosis (AS), chronic renal failure (CRF), and von Willebrand's disease, but there are no studies using SBCE to assess association with underlying diseases. The purpose of this case-control study was to evaluate the association of various medical comorbidities with SBAs in patients who underwent SBCE at our academic medical center over a 10 year period. Methods: The study involved a retrospective chart review of 899 patients who were referred to our center for SBCE or had completed SBCE as inpatients due to OGIB. Patients with SBAs were age and sex matched in 1:2 ratio to controls. Charts were reviewed for presence of comorbid conditions. Descriptive statistics were performed on all variables of interest. Logistic regression was used to estimate the strength of association between SBAs and comorbid conditions. All multivariate analyses were adjusted for age and gender. P values of <0.05 were considered significant. Results: Sixty-eight patients (68/ 899, 7.56%) had SBAs identified. The mean age of patients with SBAs was 70.4 ± SD 9.10 years. Forty-eight percent were women. There were no patients with von Willebrand's disease. Peripheral vascular disease (adjusted OR= 7.50 95% CI 1.31- 42.9), CRF (adjusted OR= 2.87 95% CI 1.06-7.75), smoking (adjusted OR= 2.56 95% CI 1.07-6.14), and history of seizures (adjusted OR= 7.63 95% CI 1.03-56.8) were significantly associated with increased risk of SBAs. History of stroke was significantly associated with SBAs in univariate but not with multivariate analysis. The combination of AS and SBAs, also known as Hyede's syndrome, was seen in only 5/68 patients; in this cohort, this was not a statistically significant association (adjusted OR= 1.55 95% CI 0.44-5.4). Conclusion: CRF was associated with SBAs but AS was not. Interestingly, stroke, history of seizures, peripheral vascular disease, and smoking were among conditions that have not been previously described as risk factors for SBAs. Further studies to confirm and evaluate these associations and their underlying pathophysiology should be explored.