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World J Gastroenterol. Jul 14, 2014; 20(26): 8416-8423
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8416
Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature
Adnan Muhammad, Gitanjali Vidyarthi, Patrick Brady
Adnan Muhammad, Patrick Brady, Division of Digestive Diseases and Nutrition, University of South Florida, Morsani College of Medicine, Tampa, FL 33620, United States
Gitanjali Vidyarthi, Division of Gastroenterology, James A Haley VA Hospital, Tampa, FL 33620, United States
Author contributions: Muhammad A, Vidyarthi G and Brady P contributed equally to the manuscript.
Correspondence to: Adnan Muhammad, MD, Division of Digestive Diseases and Nutrition, University of South Florida, Morsani College of Medicine, 12901 Bruce B. Downs Blvd, Tampa, FL 33620, United States. adnan_muhd@hotmail.com
Telephone: +1-813-9742034 Fax: +1-813-9745333
Received: November 6, 2013
Revised: January 30, 2014
Accepted: March 12, 2014
Published online: July 14, 2014
Abstract

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.

Keywords: Small bowel, Capsule endoscopy, Iron deficiency anemia, Elderly, Diagnostic yield

Core tip: Iron deficiency anemia (IDA) is a common problem especially in the elderly. Small bowel (SB) lesions may be the source of IDA. Capsule endoscopy (CE) provides direct visualization of entire SB mucosa. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA increases with advancing age. Balloon assisted enteroscopy is used to treat the lesions seen on CE causing IDA.