Angioectasias in the elderly: Interpreting the data

Angioectasias in the elderly: Interpreting the data Letter to the Editor United European Gastroenterology Journal 2018, Vol. 6(5) 791 ! Author(s) 2018 Angioectasias in the elderly: Reprints and permissions: sagepub.co.uk/journalsPermissions.nav Interpreting the data DOI: 10.1177/2050640618764166 journals.sagepub.com/home/ueg 1 2 Enrique Pe´rez-Cuadrado-Robles , Diana E Yung and Anastasios Koulaouzidis Keywords Small bowel bleeding, obscure gastrointestinal bleeding, capsule endoscopy, angioectasia, old patients We read with great interest the recent study by Nennstiel Declaration of conflicting interests et al. As reported by the authors, capsule endoscopy has None declared. a higher diagnostic yield in the elderly presenting with small bowel (SB) bleeding, where such patients are Funding more likely to present with overt bleeding compared to This research received no specific grant from any funding young patients. The clinical relevance of vascular lesions agency in the public, commercial, or not-for-profit sectors. in elderly patients may be more challenging to deter- mine, particularly in those with the presence of other References comorbidities and polypharmacy. Conversely, the inci- 1. Nennstiel S, Machanek A, von Delius S, et al. Predictors dence of vascular lesions may be underestimated in and characteristics of angioectasias in patients with young patients, where the bleeding potential may be obscure gastrointestinal bleeding identified by video cap- lower. Furthermore, at present, discriminating between sule endoscopy. United European Gastroenterol J 2017; 5: P1 or P2 lesions continues to be challenging. 1129–1135. 2. Scaglione G, Russo F, Franco MR, et al. Age and video The authors concluded that age> 65 years (odds capsule endoscopy in obscure gastrointestinal bleeding: a ratio (OR): 2.15; 95% confidence interval (CI): prospective study on hospitalized patients. Dig Dis Sci 1.36–3.38; P¼ 0.001) and presentation with overt 2011; 56: 1188–1193. bleeding (OR 1.89; 95% CI: 1.22–2.94; P¼ 0.004) 3. Yung DE, Rondonotti E, Giannakou A, et al. Capsule were independent predictors for the presence of SB endoscopy in young patients with iron deficiency anaemia angioectasias. However, age may be a confounding and negative bidirectional gastrointestinal endoscopy. factor. Although multivariate analysis can help to United European Gastroenterol J 2017; 5: 974–981. exclude confounding factors, a prospective study 4. Ponte A, Pe´ rez-Cuadrado Robles E, Pinho R, et al. High remains the gold standard to minimize bias in detecting short-term rebleeding rate in patients undergoing a second clinical predictors. Angioectasias in the elderly may be endoscopic therapy for small-bowel angioectasias after more likely to bleed, therefore presenting with overt recurrent bleeding. Rev Esp Enferm Dig 2017; 110: 88–93. signs and symptoms; furthermore, the rebleeding risk in the elderly has been shown to be higher. In this sense, identifying predictive factors for the bleeding potential of lesions would have increased clinical rele- vance, even if this is difficult to analyse in daily practice as data from asymptomatic patients presenting with vascular lesions would be necessary. Department of Hepato-gastroenterology, Cliniques Universitaires Saint- Luc, Brussels, Belgium Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK Corresponding author: Enrique Pe´rez-Cuadrado Robles, Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, 1200 Woluwe-Saint- Lambert, Brussels, Belgium. Email: kikemurcia@gmail.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png United European Gastroenterology Journal SAGE

Angioectasias in the elderly: Interpreting the data

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Publisher
SAGE Publications
Copyright
© Author(s) 2018
ISSN
2050-6406
eISSN
2050-6414
D.O.I.
10.1177/2050640618764166
Publisher site
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Abstract

Letter to the Editor United European Gastroenterology Journal 2018, Vol. 6(5) 791 ! Author(s) 2018 Angioectasias in the elderly: Reprints and permissions: sagepub.co.uk/journalsPermissions.nav Interpreting the data DOI: 10.1177/2050640618764166 journals.sagepub.com/home/ueg 1 2 Enrique Pe´rez-Cuadrado-Robles , Diana E Yung and Anastasios Koulaouzidis Keywords Small bowel bleeding, obscure gastrointestinal bleeding, capsule endoscopy, angioectasia, old patients We read with great interest the recent study by Nennstiel Declaration of conflicting interests et al. As reported by the authors, capsule endoscopy has None declared. a higher diagnostic yield in the elderly presenting with small bowel (SB) bleeding, where such patients are Funding more likely to present with overt bleeding compared to This research received no specific grant from any funding young patients. The clinical relevance of vascular lesions agency in the public, commercial, or not-for-profit sectors. in elderly patients may be more challenging to deter- mine, particularly in those with the presence of other References comorbidities and polypharmacy. Conversely, the inci- 1. Nennstiel S, Machanek A, von Delius S, et al. Predictors dence of vascular lesions may be underestimated in and characteristics of angioectasias in patients with young patients, where the bleeding potential may be obscure gastrointestinal bleeding identified by video cap- lower. Furthermore, at present, discriminating between sule endoscopy. United European Gastroenterol J 2017; 5: P1 or P2 lesions continues to be challenging. 1129–1135. 2. Scaglione G, Russo F, Franco MR, et al. Age and video The authors concluded that age> 65 years (odds capsule endoscopy in obscure gastrointestinal bleeding: a ratio (OR): 2.15; 95% confidence interval (CI): prospective study on hospitalized patients. Dig Dis Sci 1.36–3.38; P¼ 0.001) and presentation with overt 2011; 56: 1188–1193. bleeding (OR 1.89; 95% CI: 1.22–2.94; P¼ 0.004) 3. Yung DE, Rondonotti E, Giannakou A, et al. Capsule were independent predictors for the presence of SB endoscopy in young patients with iron deficiency anaemia angioectasias. However, age may be a confounding and negative bidirectional gastrointestinal endoscopy. factor. Although multivariate analysis can help to United European Gastroenterol J 2017; 5: 974–981. exclude confounding factors, a prospective study 4. Ponte A, Pe´ rez-Cuadrado Robles E, Pinho R, et al. High remains the gold standard to minimize bias in detecting short-term rebleeding rate in patients undergoing a second clinical predictors. Angioectasias in the elderly may be endoscopic therapy for small-bowel angioectasias after more likely to bleed, therefore presenting with overt recurrent bleeding. Rev Esp Enferm Dig 2017; 110: 88–93. signs and symptoms; furthermore, the rebleeding risk in the elderly has been shown to be higher. In this sense, identifying predictive factors for the bleeding potential of lesions would have increased clinical rele- vance, even if this is difficult to analyse in daily practice as data from asymptomatic patients presenting with vascular lesions would be necessary. Department of Hepato-gastroenterology, Cliniques Universitaires Saint- Luc, Brussels, Belgium Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK Corresponding author: Enrique Pe´rez-Cuadrado Robles, Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, 1200 Woluwe-Saint- Lambert, Brussels, Belgium. Email: kikemurcia@gmail.com

Journal

United European Gastroenterology JournalSAGE

Published: Jun 1, 2018

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