SIGNIFICANT CAUSE FOR OCCULT ANAEMIA DEMONSTRATED WITH MACROSCOPICALLY ABNORMAL MUCOSAE FROM ROUTINE COLONOSCOPIC ILEAL INSPECTION

Aims:

Small bowel disease is a significant cause of occult iron deficiency anaemia (IDA). Terminal ileal (TI) endoscopic examination is a recognised modality in investigating disease of the small intestine. We investigated the diagnostic value of routine TI inspection and biopsy of macroscopically abnormal terminal ileum mucosa in the investigation of anaemia.

Methods:

A single centre retrospective review, using Unisoft GI Reporting Tool and electronic patient records, of all colonoscopies (323) performed by a single endoscopist (KT) over 12 months (January 2014-December 2014). Subjects with request indication for anaemia, and confirmed on laboratory indices for anaemia were identified

Results:

Anaemia was identified in 80/323 patients. TI intubation was recorded in 60/80 (75%). 54/60 (90%) had normal TI appearances. 6/60 (10%) had macroscopically abnormal TI, including mucosal aphthous ulcerations, erosions and congestion. TI biopsies of these 6 subjects revealed histological abnormalities in 4/6 (67%). 2/6 had histologic features of new diagnosis IBD, accounting for the cause of anaemia. Of the other two patients with abnormal histology, one had a known diagnosis of Crohns disease. Of 2/6 with normal histology, one had caecal angiodysplasia, and the other showed pancolitis with backwash ileitis.

The 3 most common causes for anaemia in the 33/54 (61%) with normal TI were colonic polyps (13%), angiodysplasia (7%) and oesophageal ulcers (5%). 21/54 (39%) of the remaining normal TI had unspecified cause for anaemia. Where TI intubation was not recorded, cause of anaemia was accounted for in 12/20 – malignancy 7/12, CKD 3/12 and colonic polyps 3/12

Conclusions:

In anaemia with macroscopically abnormal TI, a third (33%) of subjects revealed significant abnormal histology indicating a new diagnosis of IBD. A further 16% showed non-IBD ileitis to account for the cause of anaemia. Routine TI intubation and histologic assessment of macroscopically abnormal mucosae should be considered at colonoscopy in the assessment of anaemia.