Small Intestinal Lesions in Patients with Anemia on Hemodialysis: A Two-Center, Cross-Sectional Study

AIM

The number of patients on chronic dialysis in Japan is increasing every year, and the average age of these patients is also increasing annually. Iron deficiency is an important cause of anemia in patients on hemodialysis (HD). However, it has not been clarified whether these patients might have small intestinal mucosal lesions causing iron deficiency anemia.

METHODS

We conducted a cross-sectional study in -asymptomatic patients on HD between April 2014 and -December 2015. We performed small bowel capsule endoscopy (SBCE) and analyzed the relationship between small intestinal endoscopic findings and anemia.

RESULTS

SBCE was successfully completed in 39 eligible patients. Univariate analysis revealed that there was a significant difference in blood hemoglobin levels between the morbid SBCE-finding group (median 7.7 g/dL; range 6.7-9.2 g/dL) and the non-morbid SBCE-finding group (median 10.65 g/dL; range 6.4-13.1 g/dL; p = 0.0006, Mann-Whitney U test). On multivariate analysis, the blood hemoglobin level was an independent predictor of morbid SBCE findings (p = 0.0033). The cutoff value of blood hemoglobin level for the morbid SBCE finding was determined as 9.2 g/dL using receiver operating characteristic curve analysis.

CONCLUSIONS

Patients on HD with anemia are at a high risk of small intestinal lesions. Since the control of small intestinal lesion may improve the anemia, these outcomes are significant factors for managing patients on HD.

Association between fatty liver and small intestinal mucosal lesions

AIM: To assess the association between fatty liver and small intestinal mucosal lesions.

METHODS: After obtaining approval from the ethical review committee of the First Affiliated Hospital of Guangdong Pharmaceutical University, from August 2011 to August 2015, patients who were excluded as having cancer or primary intestinal disease and NSAID takers were divided into a fatty liver group (case group) and a group without liver disease (control group). Intestinal lesions were detected by capsule endoscopy, and the correlation of capsule endoscopy scoring index with fatty liver index was analyzed.

RESULTS: Of 350 individuals, 60 diagnosed with fatty liver by CT or B ultrasound were included in the case group, and 290 without liver diseases were included in the control group. The incidence of small bowel mucosal lesions and the Lewis score in the case group were significantly higher than those in the control group (75.0% vs 33.8%, P < 0.001; 121.00 ± 178.51 vs 61.08 ± 144.10, P = 0.005). In fatty liver patients, the incidence rates of small intestinal edema in the upper, middle and lower third were 7.1%, 15.7%, and 4.3% (P < 0.001), respectively, and the incidence rates of small intestinal ulcers were 2.0%, 2.6%, and 3.4% (P = 0.498), respectively. Liver noninvasive NAFLD-FS score was positively correlated with the small intestinal mucosa damage score (r = 0.108, P = 0.043). Insulin resistance index was positively correlated with small intestinal damage score (r = 0.162, P = 0.034).

CONCLUSION: Fatty liver disease may be related to the small intestine lesions, and triglycerides may be an important factor. Most lesions are located in the proximal or middle small bowel.

Mesenteric CT angiography for diagnosis of primary small intestinal space-occupying lesions

AIM: To investigate the diagnostic value of mesenteric computed tomography (CT) angiography in elderly patients with primary small intestinal space-occupying lesions.

METHODS: A retrospective analysis was performed of 100 elderly patients with primary small intestinal lesions who underwent mesenteric CT angiography. Two radiologists localized and diagnosed the lesions using artery location method and Cole's method. The diagnostic accuracy was compared between different methods and radiologists.

RESULTS: Of the 100 cases of small intestinal lesions detected by CT angiography, 28 showed arterial enlargement, 21 showed venous enlargement and tortuosity, 29 produced tumor vessels, and 47 had enlargement and thickening of the vasa recta on the mesenteric side. The accuracy of artery location method and Cole's method was 99% and 85%, respectively, and both were accurate in venous localization in the duodenum and ileocecal regions. The accuracy of the artery location method was relatively low in the ileum and jejunum (76.6% and 55.6%). Two radiologists had high consistency (Kappa = 1.00, P = 0.000) when using the artery location method, and moderate consistency (Kappa = 0.54, P = 0.000) when using the Coles method. There was no significant difference in localization accuracy between the two physicians (P > 0.05).

CONCLUSION: Mesenteric CT angiography can clearly show the blood supplying vessels of primary small intestinal lesions and therefore contribute to the localization and qualitative diagnosis of these lesions.