Clinical and investigative profile of small bowel bleeding in south India

Background: Small bowel bleeding refers to patients presenting with a source of bleeding identified in the small intestine. It accounts for only 5-10% of all patients presenting with gastrointestinal bleeding. Patients present with either overt bleeding or occult bleeding manifesting as iron deficiency anaemia. Various modalities are used to diagnose the cause of small bowel bleeding which include imaging, video capsule endoscopy, enteroscopy. Objectives : Data on the small bowel bleeding in India is sparse. The aim of the present study is to identify the clinical profile of patients presenting with small bowel bleed and to evaluate the diagnostic accuracy of various modalities. Methods: Present study is prospective observational study conducted at teritiary care hospital in South India Results: Overall 56 patients with potential small bowel bleed were included in the study. 34(60%) patients presented with overt small bowel bleed and the remaining 22(40%) patients presented with occult small bowel bleed. 50 patients underwent capsule endoscopy and the mean capsule time was 10hr 1min ± 1hr 7min. Capsule endoscopic findings include vascular lesions in 10 (20%) patients, tumor in 4(8%), worm infestation in 4 (8%) patients, ulceration in 10(20%) patients. Balloon enteroscopy was performed in 39(70%) patients. Balloon enteroscopy findings include vascular lesions in 10 patients, crohns like picture in 8 patients, NSAIDS induced ulcers in 7 patients. Diagnostic yield of capsule endoscopy was 76% and enteroscopy was 77%. Overall 40 patients out of 56 have been identified with definite source of small bowel bleeding and were subjected to therapy. Out of 40 patients 20 had endotherapy, 9 patients underwent surgery, 6 patients diagnosed as crohns, 2 patients diagnosed as small bowel tuberculosis and remaining on conservative therapy. Conclusions: Small bowel bleeding accounts for 5-10% of GI bleeding. Contrary to western population infections are common cause, patients are two decades younger and overt GI bleeding was more common than occult bleeding. The diagnostic yield of capsule endoscopy in the present study is 76%. In the present study diagnostic yield of SBE/DBE combined was 77% and successful therapeutic intervention was performed in 50% of patients. Enteroscopy is slightly better than VCE and therapeutic intervention can be performed. Present study the rebleeding rate is 18% at the end of one year follow up. To our knowledge this is the first study comparing VCE and DBE/SBE with followup for one year.