Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
J Gastroenterol Hepatol. 2019 Sep;34(9):1511-1516. doi: 10.1111/jgh.14682. Epub 2019 Jun 6.
This study aimed to assess the clinical utility of computed tomography enterography (CTE) and identify factors associated with a diagnostic CTE for patients with obscure gastrointestinal bleeding (OGIB).
A retrospective observational study was performed at a Canadian tertiary care center from 2005 to 2015. A total of 138 patients underwent a CTE for OGIB. Univariate and multivariate logistic regressions were performed to determine factors associated with a diagnostic CTE. A highly sensitive clinical rule was then developed to help identify OGIB patients for whom a CTE may be beneficial in their clinical work-up.
A possible bleeding source was identified in 30 (22%) cases. The presence of abdominal or constitutional symptoms as well as history of colorectal cancer was significantly associated with a positive CTE in univariate and multivariate analyses (P < 0.05). A positive CTE could be predicted based on the presence of abdominal or constitutional symptoms and history of colorectal cancer with 90% sensitivity (95% CI 74-98%) in our population.
CTE identified a possible source of OGIB in one in five cases. In patients with the presence of abdominal or constitutional symptoms and a personal history of colorectal cancer, CTE may contribute to their diagnostic work-up.
本研究旨在评估 CT 肠造影（CTE）的临床实用性，并确定与不明原因胃肠道出血（OGIB）患者诊断性 CTE 相关的因素。
本研究在加拿大的一家三级医疗中心进行了一项回顾性观察性研究，2005 年至 2015 年期间共有 138 例患者因 OGIB 接受了 CTE。采用单因素和多因素逻辑回归分析确定与诊断性 CTE 相关的因素。然后开发了一种高度敏感的临床规则，以帮助确定 OGIB 患者，在其临床评估中 CTE 可能有益。
在 30 例（22%）患者中发现了可能的出血源。在单因素和多因素分析中，腹部或全身症状以及结直肠癌病史与 CTE 阳性显著相关（P<0.05）。在我们的人群中，基于腹部或全身症状以及结直肠癌病史的存在，CTE 可预测阳性 CTE 的敏感性为 90%（95%CI 74-98%）。
CTE 在五分之一的 OGIB 病例中确定了可能的出血源。在存在腹部或全身症状和结直肠癌个人史的患者中，CTE 可能有助于其诊断性评估。
