Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2015; 21(23): 7242-7247
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7242
Risk factors for small bowel angioectasia: The impact of visceral fat accumulation
Atsuo Yamada, Ryota Niikura, Yuka Kobayashi, Hirobumi Suzuki, Shuntaro Yoshida, Hirotsugu Watabe, Yutaka Yamaji, Yoshihiro Hirata, Kazuhiko Koike
Atsuo Yamada, Ryota Niikura, Yuka Kobayashi, Hirobumi Suzuki, Shuntaro Yoshida, Hirotsugu Watabe, Yutaka Yamaji, Yoshihiro Hirata, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Shuntaro Yoshida, Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
Author contributions: Yamada A designed the research, performed the research, analyzed the data, and wrote the paper; Niikura R, Kobayashi Y and Suzuki H performed the research and edited the manuscript; Yoshida S, Watabe H, Yamaji Y, Hirata Y and Koike K revised the manuscript; all authors read and approved the submitted version of the manuscript; all authors discussed the contents and commented on the manuscript.
Conflict-of-interest: The authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Atsuo Yamada, MD, Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yamada-a@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-38140021
Received: December 15, 2014
Peer-review started: December 16, 2014
First decision: January 8, 2015
Revised: January 25, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: June 21, 2015
Processing time: 186 Days and 22.7 Hours
Abstract

AIM: To investigate visceral fat accumulation in association with the risk of small bowel angioectasia.

METHODS: We retrospectively investigated 198 consecutive patients who underwent both capsule endoscopy and CT for investigation of obscure gastrointestinal bleeding (OGIB) from January 2009 to September 2013. The visceral fat area (VFA) and subcutaneous fat area were measured by CT, and information on comorbidities, body mass index, and medications was obtained from their medical records. Logistic regression analysis was used to evaluate associations.

RESULTS: Capsule endoscopy revealed small bowel angioectasia in 18/198 (9.1%) patients with OGIB. Compared to patients without small bowel angioectasia, those with small bowel angioectasia had a significantly higher VFA (96 ± 76.0 cm2vs 63.4 ± 51.5 cm2, P = 0.016) and a higher prevalence of liver cirrhosis (61% vs 22%, P < 0.001). The proportion of patients with chronic renal failure was higher in patients with small bowel angioectasia (22% vs 9%, P = 0.11). There were no significant differences in subcutaneous fat area or waist circumference. The prevalence of small bowel angioectasia progressively increased according to the VFA. Multivariate analysis showed that the VFA [odd ratio (OR) for each 10-cm2 increment = 1.1; [95% confidence interval (CI): 1.02-1.19; P = 0.021] and liver cirrhosis (OR = 6.1, 95%CI: 2.2-18.5; P < 0.001) were significant risk factors for small bowel angioectasia.

CONCLUSION: VFA is positively associated with the prevalence of small bowel angioectasia, for which VFA and liver cirrhosis are independent risk factors in patients with OGIB.

Keywords: Capsule endoscopy; Obscure gastrointestinal bleeding; Small bowel angioectasia; Visceral fat accumulation

Core tip: Small bowel angioectasia is a major source of obscure gastrointestinal bleeding. The etiology and mechanism of the development of angioectasia are not fully understood. In this study, we elucidated the association of visceral fat accumulation with the risk of small bowel angioectasia. A positive association was observed between visceral fat accumulation and the prevalence of small bowel angioectasia. Visceral fat accumulation and liver cirrhosis are independent risk factors for small bowel angioectasia in patients with obscure gastrointestinal bleeding.