Small Bowel Angiodysplasia (sba) in Minority Populations: Where to Find It?

Introduction: The small bowel (SB) harbors up to 10% of identified lesions deemed responsible for gastrointestinal bleeding of which SBA is the most common. Available data on the distribution of SBA, however, are very scarce and non-existent for minority populations. Methods: We retrospectively reviewed medical records and imaging studies of adult patients who were evaluated with video capsule endoscopy (VCE) at our medical center between 1/2009 and 6/2015 for iron deficiency anemia, with or without occult or overt GIB, after undergoing unremarkable upper endoscopy and colonoscopy. Patients with suboptimal preparation or an incomplete study were excluded from analysis. The location of SBAs was classified as proximal, middle, or distal SB depending on SB transit time as determined by the VCE software. Pertinent clinical and demographic data were collected. Statistical analysis was done using SPSS. Results: 228 patients met the inclusion criteria (35% men, 65% women; mean age 66 years). There were 84 African Americans, 49 Hispanics, 37 Whites, and 37 patients with a multiracial background; 21 patients had declined to disclose their race. 102 patients had SBA of whom 39 patients had SBA in more than one segment of the SB. We found proximal SBA in 81 patients (35.5%), middle SBA in 42 patients (18.4%), and distal SBA in 42 patients (18.4%). On univariate analysis, age > 60 years (P=0.01), chronic kidney disease (CKD, P=0.008), and cirrhosis (P < 0.001) were associated with higher prevalence of proximal SBA. On multivariate logistic regression analysis, only CKD (OR 1.8, CI 1.02-3.4, P=0.04) and cirrhosis (OR 4.2, CI 1.7-10.5, P=0.002) retained statistical significance. No similar associations were found for middle or distal SBAs. Moreover, there was no statistically significant association of SBA distribution with gender, race, antiplatelet therapy, or anticoagulation. Conclusion: This is the largest and most comprehensive evaluation of the distribution of SBA and the first analysis of its kind in urban minority populations. Our results show that the proximal SB is the most common site for SBA in patients with potential SB bleeding. Proximal SBA is even more common in patients with CKD or cirrhosis. These findings might suggest an increased yield for push enteroscopy in this patient population, but further studies are warranted to validate this conclusion.