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Predictive Model for Positive Video Capsule Endoscopy in Iron Deficiency Anemia

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Abstract

Background and Aims

Bleeding from the gastrointestinal tract can contribute to the development of iron deficiency anemia (IDA) among individuals without another obvious source of bleeding. In order to identify patients most likely to benefit from examination of the small bowel, our aim was to create a risk score for positive video capsule endoscopy (VCE) in IDA utilizing a multicenter collection of studies.

Methods

We performed a retrospective multicenter study utilizing VCE studies performed for an indication of IDA between 1/1/2005 and 7/31/2018. VCE findings were graded based on the P0–P2 grading system. The primary outcome of interest was a positive (P2) VCE. Data were analyzed with Student’s t test for continuous variables and the Fisher’s exact test for categorical variables. Logistic regression was used to identify independent associations with positive VCE.

Results

In total, 765 VCE procedures were included with 355 (46.5%) male subjects and a median age of 63.2 (SD 15.3) years. One hundred ninety studies (24.8%) were positive (P2) for small bowel bleeding. Four variables associated with positive VCE which were incorporated into a point scoring system: (+) 1 for age ≥ 66 years, active smoking and cardiac arrythmia and (−) 1 for preceding hemoglobin level ≥ 8.5. The risk probabilities for positive VCE-assigned scores − 1, 0, 1, and 2 + were 12.3% (95% CI 7.3–17.3%), 20% (14.9–25.1%), 34.8% (28.6–41%), and 39% (30–47.8%).

Conclusion

In order to improve the diagnostic yield of capsule examinations, risk factors should be applied to clinical decision-making. We created a risk score for positive VCE in IDA, including the risk factors of age, smoking, history of cardiac arrythmia, and preceding hemoglobin level.

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Abbreviations

VCE:

Video capsule endoscopy

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA

    Shadi Hamdeh, Scott Grisolano & Mojtaba Olyaee

  2. Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Jihan Fathallah & Khaldoun Haj Mahmoud

  3. The Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA

    Hui Zhang

  4. Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, John Hopkins University School of Medicine, Baltimore, MD, USA

    Amber Charoen

  5. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA, USA

    Barakat Aburajab Altamimi & Amer El Sayed

  6. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA

    Florence-Damilola Odufalu, Christine Hachem & Muhammad Bader Hammami

  7. Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA

    Devashree Dave

  8. Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA

    Laura R. Glick, Vijaya L. Rao, Carol Semrad & Dejan Micic

  9. Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA, USA

    Alexander N. Levy & Hong Gi Shim

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  1. Shadi Hamdeh
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Contributions

All authors have reviewed and approved the final manuscript submission. SH, FDO, MO, and DM contributed to conception and design, acquisition, analysis or interpretation and drafting of manuscript. HZ and AC contributed to analysis or interpretation and critical review of manuscript. JF, BAA, DD, AES, LRG, SG, CH, MBH, KHM, ANL, VLR, HS, and CS contributed to acquisition, analysis or interpretation, and critical review of manuscript.

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Correspondence to Dejan Micic.

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Hamdeh, S., Fathallah, J., Zhang, H. et al. Predictive Model for Positive Video Capsule Endoscopy in Iron Deficiency Anemia. Dig Dis Sci 68, 3083–3091 (2023). https://doi.org/10.1007/s10620-023-07918-0

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