• Adult
• Aged
• Aged, 80 and over
• Humans
• Anemia, Iron-Deficiency/blood
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Capsule Endoscopy/methods
• Gastrointestinal Hemorrhage/blood
• Gastrointestinal Hemorrhage/complications
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/pathology
• Intestine, Small/blood supply
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Young Adult
• Middle Aged

• Diagnostic work-up
• Iron deficiency anaemia
• Small bowel
• Videocapsule endoscopy

• Humans
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/epidemiology
• Anemia, Iron-Deficiency/etiology
• Gastrointestinal Hemorrhage/etiology
• Capsule Endoscopy/adverse effects
• Intestine, Small/pathology

• Capsule endoscopy
• colon capsule
• endoscopy
• imaging
• magnetic capsule
• small bowel

Small bowel malignancies are rare and usually asymptomatic or symptoms are nonspecific. Therefore, small bowel tumors are difficult to diagnose. In patients with iron deficiency anemia (IDA) who have negative bidirectional endoscopy results, the small bowel may be considered the source of bleeding. However, in asymptomatic IDA patients with negative bidirectional endoscopy results, evidence supporting the routine use of capsule endoscopy (CE) is insufficient. CE can be considered in selected patients with recurrent or persistent IDA. The frequency of small bowel malignancies is low in patients undergoing CE for IDA, but the usefulness of CE for the diagnosis of small bowel malignancies in younger age groups with IDA has been reported. For patients with risk factors for small bowel malignancy, investigation of the small bowel should be considered. Efforts should be made to prevent adverse events, such as capsule retention or capsule aspiration, through meticulous history taking and endoscopic capsule delivery as necessary.

• Capsule endoscopy
• Fecal occult blood test
• Gastrointestinal bleeding
• Iron deficiency anemia
• Predictive factors

• Bleeding
• Endoscopy
• Ferritin
• Gastrointestinal
• Hematocrit
• Hemoglobin
• Occult

• Adolescent
• Adult
• Age Factors
• Anemia, Iron-Deficiency/blood
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Biopsy
• Child
• Endoscopy, Gastrointestinal/standards
• Evidence-Based Medicine/standards
• Female
• Gastric Mucosa/diagnostic imaging
• Gastric Mucosa/metabolism
• Gastric Mucosa/pathology
• Gastroenterology/standards
• Gastrointestinal Diseases/blood
• Gastrointestinal Diseases/complications
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/pathology
• Hemoglobins/analysis
• Humans
• Intestinal Mucosa/diagnostic imaging
• Intestinal Mucosa/metabolism
• Intestinal Mucosa/pathology
• Iron/blood
• Iron/metabolism
• Male
• Middle Aged
• Prevalence
• Reference Values
• Sex Factors
• Societies, Medical/standards
• United States
• Young Adult

• P30 DK123704 NIDDK NIH HHS

• Anaemia
• Celiac disease
• Endoscopy
• H. pylori
• Inflammatory bowel disease
• Iron deficiency
• Small bowel

• NSAIDs
• PPIs
• anemia
• obscure occult bleeding
• videocapsule endoscopy

• Adult
• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency/complications
• Anemia, Iron-Deficiency/drug therapy
• Anemia, Iron-Deficiency/pathology
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Capsule Endoscopy
• Female
• Gastrointestinal Hemorrhage/etiology
• Hospitals, University
• Humans
• Inpatients
• Intestine, Small/pathology
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Occult Blood
• Prevalence
• Proton Pump Inhibitors/adverse effects
• Proton Pump Inhibitors/therapeutic use
• Retrospective Studies
• Risk Factors
• Tertiary Care Centers
• Young Adult

Small bowel capsule endoscopy is a minimally-invasive endoscopic investigation that is often used in clinical practice to investigate overt or occult gastrointestinal (GI) bleeding among other clinical indications. International guidance recommends small bowel capsule endoscopy as a first-line investigation to detect abnormalities in the small bowel, when gastroscopy and colonoscopy fail to identify a cause of GI bleeding. It can diagnose with accuracy abnormalities in the small bowel. However, there has been increasing evidence indicating that small bowel capsule endoscopy may also detect lesions outside the small intestine that are within the reach of conventional endoscopy and have been probably missed during prior endoscopic investigations. Such lesions vary from vascular deformities to malignancy and their detection often alters patient management, leading to further endoscopic and/or surgical interventions. The current study attempts to review all available studies in the literature and summarise their relevant findings.

• Obscure gastrointestinal bleeding
• Small bowel capsule endoscopy
• Non-small bowel lesions
• Overt gastrointestinal bleeding
• Occult gastrointestinal bleeding
• Iron deficiency anaemia

• Celiac
• Coeliac
• Iron Deficiency
• Meta-Analysis

• Age Factors
• Anemia, Iron-Deficiency/epidemiology
• Anemia, Iron-Deficiency/etiology
• Anemia, Iron-Deficiency/pathology
• Biopsy
• Celiac Disease/complications
• Celiac Disease/epidemiology
• Celiac Disease/pathology
• Humans
• Intestine, Small/pathology
• Prevalence
• Sex Factors

• T32 DK083256 NIDDK NIH HHS

• iron deficiency anemia
• obscure gastrointestinal bleeding
• small bowel bleeding
• video capsule endoscopy

• Adult
• Aged
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Capsule Endoscopy/methods
• Cohort Studies
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage/complications
• Gastrointestinal Hemorrhage/diagnosis
• Hemoglobins/analysis
• Humans
• Male
• Middle Aged
• Prognosis
• Recurrence
• Retrospective Studies

• Anemia
• capsule
• colonoscopy
• enteroscopy
• gastroscopy
• polyp

To evaluate the adequacy of the study of iron deficiency anemia (IDA) in real life practice prior to referral to a gastroenterology department for small bowel evaluation.

All consecutive patients referred to a gastroenterology department for small bowel investigation due to iron deficiency anemia, between January 2013 and December 2015 were included. Both patients referred from general practitioners or directly from different hospital departments were selected. Relevant clinical information regarding prior anemia workup was retrospectively collected from medical records. An appropriate pre-referral study was considered the execution of esophagogastroduodenoscopy (EGD) with Helicobacter pylori (H. pylori) investigation, colonoscopy with quality standards (recent, total and with adequate preparation) and celiac disease (CD) screening (through serologic testing and/or histopathological investigation).

A total of 77 patients (58.4% female, mean age 67.1 ± 16.7 years) were included. Most (53.2%) patients were referred from general practitioners, 41.6% from other hospital specialties and 5.2% directly from the emergency department. The mean pre-referral hemoglobin concentration was 8.8 ± 2.0 g/dL and the majority of anemias had microcytic (71.4%) and hypochromic (72.7%) characteristics. 77.9% of patients presented with an incomplete pre-referral study: EGD in 97.4%, with H. pylori investigation in 58.3%, colonoscopy with quality criteria in 63.6%, and CD screening in 24.7%. Patients with an appropriate study at the time of referral were younger (48.7 ± 17.7 vs 72.3 ± 12.3 years, P < 0.001). Small bowel evaluation was ultimately undertaken in 72.7% of patients, with a more frequent evaluation in patients with a quality colonoscopy at referral (78.6% vs 23.8%); P < 0.001 (OR = 11.7, 95%CI: 3.6-38.6). The most common diagnosis regarded as the likely cause of IDA was small bowel angioectasia (18.2%) but additional causes were also found in the upper and lower gastrointestinal tracts of near 20% of patients. Small bowel studies detected previously unknown non-small bowel findings in 7.7% of patients.

The study of anemia prior to referral to gastroenterology department is unsatisfactory. Only approximately a quarter of patients presented with an appropriate study.

• Iron deficiency anemia
• Colonoscopy
• Celiac disease
• Esophagogastroduodenoscopy
• Helicobacter pylori
• Small bowel

• Age Factors
• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency/blood
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Angiodysplasia/complications
• Celiac Disease/blood
• Celiac Disease/diagnosis
• Celiac Disease/microbiology
• Celiac Disease/pathology
• Endoscopy, Digestive System
• Female
• Gastrointestinal Hemorrhage/blood
• Gastrointestinal Hemorrhage/complications
• Helicobacter pylori/isolation & purification
• Hemoglobins/analysis
• Humans
• Intestine, Small/blood supply
• Intestine, Small/diagnostic imaging
• Intestine, Small/microbiology
• Male
• Middle Aged
• Practice Guidelines as Topic
• Practice Patterns, Physicians'/standards
• Referral and Consultation
• Retrospective Studies
• Social Validity, Research
• Telangiectasis
• Tertiary Care Centers/organization & administration
• Tertiary Care Centers/standards

• Anemia
• Capsule endoscopy
• Capsule enteroscopy
• IDA
• SBCE
• VCE

Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications.

Retrospective observational study.

DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE.

In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant.

• Anemia
• Capsule endoscopy
• Double-balloon endoscopy
• Hemorrhage
• Intestine, small

• Capsule Endoscopy
• Chronic Disease
• Gastrointestinal Hemorrhage
• Intestinal Neoplasms
• Small Intestine

• Adult
• Aged
• Aged, 80 and over
• Angiodysplasia/blood
• Angiodysplasia/complications
• Angiodysplasia/genetics
• Angiogenesis Inducing Agents/metabolism
• Antigens, CD/blood
• Biopsy
• Case-Control Studies
• Endoglin
• Enzyme-Linked Immunosorbent Assay
• Female
• Gastrointestinal Hemorrhage/blood
• Gastrointestinal Hemorrhage/genetics
• Humans
• Intestinal Diseases/blood
• Intestinal Diseases/complications
• Intestinal Diseases/genetics
• Intestine, Small/blood supply
• Male
• Middle Aged
• Platelet-Derived Growth Factor/metabolism
• Receptor, TIE-2/metabolism
• Receptors, Cell Surface/blood
• Ribonuclease, Pancreatic/blood
• Tumor Necrosis Factor-alpha/blood
• Vascular Endothelial Growth Factor A/blood
• Vesicular Transport Proteins/blood

Iron is an important micronutrient that may be depleted in celiac disease. Iron deficiency and anemia may complicate well-established celiac disease, but may also be the presenting clinical feature in the absence of diarrhea or weight loss. If iron deficiency anemia occurs, it should be thoroughly evaluated, even if celiac disease has been defined since other superimposed causes of iron deficiency anemia may be present. Most often, impaired duodenal mucosal uptake of iron is evident since surface absorptive area in the duodenum is reduced, in large part, because celiac disease is an immune-mediated disorder largely focused in the proximal small intestinal mucosa. Some studies have also suggested that blood loss may occur in celiac disease, sometimes from superimposed small intestinal disorders, including ulceration or neoplastic diseases, particularly lymphoma. In addition, other associated gastric or colonic disorders may be responsible for blood loss. Rarely, an immune-mediated hemolytic disorder with increased urine iron loss may occur that may respond to a gluten-free diet. Reduced expression of different regulatory proteins critical in iron uptake has also been defined in the presence and absence of anemia. Finally, other rare causes of microcytic anemia may occur in celiac disease, including a sideroblastic form of anemia reported to have responded to a gluten-free diet.

• Anemia
• Iron deficiency
• Autoimmune hemolysis
• Celiac disease
• Iron absorption
• Ferroportin
• Hepcidin
• Divalent metal transporter
• Enterocyte

• Anemia, Iron-Deficiency/blood
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Cation Transport Proteins/metabolism
• Celiac Disease/blood
• Celiac Disease/complications
• Celiac Disease/diagnosis
• Celiac Disease/diet therapy
• Diet, Gluten-Free
• Duodenum/metabolism
• Duodenum/pathology
• Gastrointestinal Hemorrhage/blood
• Gastrointestinal Hemorrhage/etiology
• Hemolysis
• Humans
• Intestinal Absorption
• Iron/blood
• Risk Factors
• Treatment Outcome

A 29-year-old woman presented with profound iron-deficiency anemia. Cross-sectional imaging identified a mass in the ileal mesentery. Surgical resection was curative and revealed a giant cystic arteriovenous malformation. Our report highlights the role of cross-sectional imaging in the evaluation and management of iron-deficiency anemia and obscure gastrointestinal hemorrhage.

• capsule endoscopy
• double-balloon enteroscopy
• esophageal capsule endoscopy
• gastroesophageal reflux disease
• inflammatory bowel disease

Video capsule endoscopy (VCE) was launched in 2000 and has revolutionized direct endoscopic imaging of the gut. VCE is now a first-line procedure for exploring the small bowel in cases of obscure digestive bleeding and is also indicated in some patients with Crohn’s disease, celiac disease, and polyposis syndrome. A video capsule has also been designed for visualizing the esophagus in order to detect Barrett’s esophagus or esophageal varices. Different capsules are now available and differ with regard to dimensions, image acquisition rate, battery life, field of view, and possible optical enhancements. More recently, the use of VCE has been extended to exploring the colon. Within the last 5 years, tremendous developments have been made toward increasing the capabilities of the colon capsule. Although colon capsule cannot be proposed as a first-line colorectal cancer screening procedure, colon capsule may be used in patients with incomplete colonoscopy or in patients who are unwilling to undergo colonoscopy. In the near future, new technological developments will improve the diagnostic yield of VCE and broaden its therapeutic capabilities.

• Video capsule endoscopy
• Esophagus
• Small bowel
• Colon
• Obscure digestive bleeding
• Polyp

• Animals
• Capsule Endoscopes
• Capsule Endoscopy/adverse effects
• Capsule Endoscopy/instrumentation
• Capsule Endoscopy/methods
• Capsule Endoscopy/trends
• Colon/pathology
• Diffusion of Innovation
• Equipment Design
• Esophageal Diseases/diagnosis
• Esophageal Diseases/pathology
• Esophagus/pathology
• Forecasting
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/pathology
• Intestine, Small/pathology
• Predictive Value of Tests
• Prognosis

Iron deficiency anemia (IDA) is common and often under recognized problem in the elderly. It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract. Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel (SB). Capsule endoscopy (CE) provides direct visualization of entire SB mucosa, which was not possible before. It is superior to push enteroscopy, enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA progressively increases with advancing age, and is highest among patients over 85 years of age. Balloon assisted enteroscopy is used to treat the lesions seen on CE. CE has some limitations mainly lack of therapeutic capability, inability to provide precise location of the lesion and false positive results. Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.

• Small bowel
• Capsule endoscopy
• Iron deficiency anemia
• Elderly
• Diagnostic yield

• Age Factors
• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/pathology
• Anemia, Iron-Deficiency/therapy
• Capsule Endoscopy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/pathology
• Gastrointestinal Hemorrhage/therapy
• Hemostatic Techniques
• Humans
• Intestinal Mucosa/pathology
• Intestine, Small/pathology
• Predictive Value of Tests
• Reproducibility of Results
• Risk Factors
• Treatment Outcome

The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.

• aetiology
• diagnostic approach
• management
• small intestine bleed

• DBE
• FDA
• Food and Drug Administration
• NSAID
• OGIB
• WCE
• double-balloon endoscopy
• nonsteroidal anti-inflammatory drug
• obscure GI bleeding
• wireless capsule endoscopy

• Capsule Endoscopes
• Capsule Endoscopy/adverse effects
• Capsule Endoscopy/instrumentation
• Celiac Disease/diagnosis
• Colon
• Crohn Disease/diagnosis
• Esophageal Diseases/diagnosis
• Esophagus
• Gastrointestinal Diseases/complications
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Humans
• Intestinal Neoplasms/diagnosis
• Intestinal Polyps/diagnosis
• Intestine, Small

• Anaemia
• Colonoscopy
• Ferric carboxymaltose
• Hepcidin
• Iron deficiency
• Upper gastrointestinal endoscopy
• Videocapsule endoscopy

• iron deficiency anemia
• colonoscopy
• endoscopy
• colorectal cancer

Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn's disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.

• Capsule endoscopy
• Guideline
• Small bowel disease