Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan.
Dig Endosc. 2013 Jul;25(4):412-20. doi: 10.1111/den.12002. Epub 2012 Dec 17.
To identify the predictive factors for the presence of small bowel lesions in patients with obscure gastrointestinal bleeding (OGIB).
A total of 242 patients with OGIB (overt 149: occult 93) were retrospectively included in the present study. Capsule endoscopy (CE) was carried out to investigate the small bowel, and detected lesions were classified according to the P0-P2 system. Only P2 lesions were defined as significant lesions. Univariate and multivariate logistic regression analyses were carried out to define the predictive factors for the presence of small bowel lesions.
In patients with overt OGIB, chronic kidney disease (CKD) ≥stage 4 (odds ratio [OR] 4.03; 95% confidence interval [CI] 1.45-11.1, P = 0.007) was identified as an independent predictor of the presence of vascular lesions, and a history of non-steroidalanti-inflammatory drug (NSAID) use as that of erosive/ulcerated lesions (OR 4.73; 95% CI 1.47-15.2, P = 0.009). However, in patients with occult OGIB, no significant predictors of the presence of vascular lesions were identified, whereas a history of low-dose aspirin (LDA) (OR 3.57; 95% CI 1.21-10.5, P = 0.02) and proton pump inhibitor (PPI) use (OR 3.18; 95% CI 1.02-9.92, P = 0.05) were identified as independent predictors of the presence of erosive/ulcerated lesions.
Our results indicated that bleeding pattern and clinical characteristics could contribute to predicting the origin of OGIB.
确定不明原因胃肠道出血（OGIB）患者存在小肠病变的预测因素。
本研究回顾性纳入 242 例 OGIB 患者（显性 149 例：隐性 93 例）。进行胶囊内镜（CE）检查以探查小肠，并根据 P0-P2 系统对发现的病变进行分类。仅将 P2 病变定义为显著病变。进行单变量和多变量逻辑回归分析，以确定小肠病变存在的预测因素。
在显性 OGIB 患者中，慢性肾脏病（CKD）≥4 期（优势比[OR]4.03；95%置信区间[CI]1.45-11.1，P=0.007）被确定为血管病变存在的独立预测因素，而非甾体抗炎药（NSAID）使用史为糜烂/溃疡性病变的预测因素（OR 4.73；95%CI 1.47-15.2，P=0.009）。然而，在隐性 OGIB 患者中，未发现血管病变存在的显著预测因素，而小剂量阿司匹林（LDA）使用史（OR 3.57；95%CI 1.21-10.5，P=0.02）和质子泵抑制剂（PPI）使用史（OR 3.18；95%CI 1.02-9.92，P=0.05）被确定为糜烂/溃疡性病变存在的独立预测因素。
我们的结果表明，出血模式和临床特征有助于预测 OGIB 的来源。
