不明原因缺铁性贫血：胶囊内镜检查是否有必要？

Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?

机构信息

Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy.

出版信息

Dig Liver Dis. 2010 Aug;42(8):560-6. doi: 10.1016/j.dld.2010.01.023. Epub 2010 Mar 15.

DOI:10.1016/j.dld.2010.01.023

PMID:20227929

Abstract

BACKGROUND

In around 30% of iron deficiency anaemia (IDA) cases a definite diagnosis cannot be made.

AIM

To investigate the role of capsule endoscopy (CE) in detecting lesions in patients with unexplained IDA after a negative endoscopic, serologic and haematologic diagnostic work up and its possible role in influencing clinical outcome.

METHODS

138 patients suffering from IDA were identified among 650 consecutive patients undergoing CE at our unit.

RESULTS

CE revealed the following positive findings in 91/138 patients: angiodysplasias in 51 patients; jejunal and/or ileal micro-ulcerations in 12; tumours/polyps in 9; erosive gastritis in 4; Crohn's disease in 5; jejunal villous atrophy in 5; a solitary ileal ulcer in 1 and active bleeding in the last 4 patients. Follow up data were available for 80/91 patients (87.9%). In 15 out of 46 patients with angiodysplasias IDA spontaneously resolved without any treatment; 9 patients required iron supplementation; 10 patients healed after lanreotide administration; APC was performed in 9 out of 46 patients and 3 patients underwent regular blood transfusion without any success on IDA. 10 out of the 12 patients with small bowel micro-ulcers spontaneously recovered from IDA whilst 2 patients after iron supplementation. All 9 patients affected by tumours/polyps were surgically addressed. In all erosive gastritis cases, patients recovered from IDA after PPI and Helicobacter pylori eradication. Four patients with Crohn's disease diagnosis restored to health with medical therapy. One out of the 4 patients with jejunal villous atrophy and the sole patient with a solitary ileal ulcer spontaneously healed. In 1 out of 3 patients with active bleeding IDA resolved without further treatment after blood transfusion whilst 2 patients were referred for surgical treatment. At follow up, complete resolution of IDA was achieved in 96.25%.

CONCLUSIONS

Small bowel investigation is a matter of great importance in IDA patients after negative upper and lower gastrointestinal endoscopy.

摘要

背景

约 30%的缺铁性贫血（IDA）病例无法明确诊断。

目的

探讨胶囊内镜（CE）在排除内镜、血清学和血液学诊断后，对不明原因 IDA 患者检测病变的作用及其对临床结果的可能影响。

方法

在我院进行 CE 的 650 例连续患者中，确定了 138 例 IDA 患者。

结果

CE 在 91/138 例患者中发现以下阳性发现：51 例血管发育不良；12 例空肠和/或回肠微溃疡；9 例肿瘤/息肉；4 例糜烂性胃炎；5 例克罗恩病；5 例空肠绒毛萎缩；1 例孤立性回肠溃疡；最后 4 例患者有活动性出血。80/91 例患者（87.9%）可获得随访数据。在 46 例血管发育不良患者中，15 例 IDA 自发缓解，无需任何治疗；9 例需要补铁；10 例接受兰瑞肽治疗后痊愈；46 例患者中 9 例行 APC，3 例因 IDA 无效而定期输血。12 例小肠微溃疡患者中，10 例自发缓解 IDA，2 例经补铁后缓解。所有 9 例肿瘤/息肉患者均接受手术治疗。所有糜烂性胃炎患者在接受质子泵抑制剂（PPI）和幽门螺杆菌根除治疗后均恢复 IDA。4 例克罗恩病患者经药物治疗后恢复健康。4 例空肠绒毛萎缩患者中，1 例自发痊愈，唯一 1 例孤立性回肠溃疡患者也自发痊愈。在 4 例活动性出血患者中，1 例输血后 IDA 无需进一步治疗即可缓解，2 例患者转至外科治疗。随访时，96.25%的患者 IDA 完全缓解。