Introduction: Despite undergoing standard endoscopic diagnostic evaluation with eosophagogastroduodenoscopy and ileocolonoscopy, up to 30 % of patients with iron deficiency anemia (IDA) have no definitive diagnosis. The aim of this study was to prospectively investigate the role of wireless capsule endoscopy (WCE) in detecting lesions of the small bowel in patients with unexplained IDA after a negative endoscopic work-up. Patients and methods: Between 1 December 2003 and 31 December 2004, 253 consecutive patients who had been referred because of unexplained IDA underwent eosophagogastroduodenoscopy with small-bowel biopsies and ileocolonoscopy. Endoscopic and histological investigations were negative in 51 of these patients (20.2 %) and WCE was performed. Air double-contrast enteroclysis was performed following WCE in all these patients. Results: Wireless capsule endoscopy revealed one or more small-bowel lesions that were considered to be a likely cause of the IDA in 29/51 patients (57 %): angiodysplasias in twelve patients (23.5 %), multiple jejunal and/or ileal ulcers in six patients (11.7 %), multiple erosions in four patients (7.8 %), a solitary ulcer in three patients (5.9 %), polyps in two patients (3.9 %), and tumors in two patients (3.9 %). Enteroclysis revealed abnormal findings likely to cause IDA in only 6/51 patients (11.8 %): multiple ileal ulcers in three patients (5.9 %), tumors in two patients (3.9 %), and polyps in one patient (1.9 %) (enteroclysis vs. WCE, P < 0.0001). WCE revealed all of the radiographic findings and no adverse events were observed. Conclusions: This study demonstrates the importance of investigating the small bowel with WCE in patients with unexplained IDA after negative standard endoscopic evaluation. Wireless capsule endoscopy is superior to enteroclysis for detecting lesions of the small bowel in patients with unexplained IDA and should be the next diagnostic test of choice after unremarkable standard endoscopic evaluation.

To evaluate changes in H pylori infection prevalence in Greece during a ten-year period, and to examine its antigenic profile. Three groups of patients were studied. Group O-87: Banked serum samples of 200 consecutive adult outpatients, from the Hepato-Gastroenterology clinic of a teaching hospital at Athens, collected in 1987. Group O-97: Serum samples of 201 similarly selected outpatients from the same Unit, collected in 1997. Group BD-97: Serum samples of 120 consecutive blood donors from the same hospital, collected in 1997. H pylori IgG antibody seroprevalence was studied by a quantitative ELISA. Antigenic profile was studied by western-blot IgG assay, in 62 IgG positive patients of O-97 and BD-97. Results were analyzed by conventional statistics and multivariate regression analysis. The H pylori seroprevalence increased with age in the three tested groups. In O-97, seroprevalence did not differ from that, in BD-97. On the contrary, there was a significant decrease in seropositivity between O-87 and O-97 (59.5% vs 49.2%, p = 0.039). Multiple regression analysis showed that age over 35 years (OR:3.45, 95% CI:1.59–7.49, p = 0.002) and year of patients' selection – that is 1987 or 1997 – (OR:1.73, 95% CI:1.14–2.65 for 1987, p = 0.010), were independent risk factors of H pylori infection. The seroprevalence of CagA+ and VacA+ strains was 77.4% and 58.5%, respectively, and type I(CagA+/VacA+) strains were significantly more common than type II(CagA-/VacA-) strains (59.7% vs 22.6%, p < 0.001). During a ten-year period, we found a significant decrease of H pylori infection in Greece and our data support the birth cohort phenomenon as an explanation for the age-dependent increase of H pylori infection. The prevalence of CagA and/or VacA positive strains is relatively high, in a country with low incidence of gastric cancer.

M2A wireless capsule endoscopy (Given Imaging, Ltd., Yoqneam, Israel) is an innovative diagnostic method that makes it possible to visualize the entire small bowel during normal peristalsis [ 1 ]. This new method appears to be superior to small-bowel radiography (enteroclysis or barium follow-through, or both) for evaluating small-bowel diseases [ 2 ] [ 3 ]. However, its true diagnostic yield is still under evaluation. We describe here the case of a 76-year-old man with a 5-year history of celiac disease, who initially had complete clinical remission and histological improvement after switching to a gluten-free diet, but whose symptoms subsequently recurred despite strict adherence to dietary restrictions. A barium follow-through showed dilation of the proximal small bowel, with loss of mucosal folds and segmentation of the barium contrast. M2A capsule endoscopy was then carried out and revealed multiple benign-appearing ulcers throughout the small bowel (Fig. [ 1 ], [ 2 ]), with patchy mucosal inflammation. The patient did not report any use of nonsteroidal anti-inflammatory drugs, and there was no evidence of bowel ischemia. Enteroscopy was subsequently carried out, and histological examination of multiple biopsies throughout the proximal small bowel did not reveal T-cell monoclonality. A laparotomy with full-thickness biopsies of the small bowel was suggested in order to exclude malignancy, but the patient declined. Computed tomography of the abdomen was normal, and prednisolone 20 mg daily was therefore administered, with iron and calcium supplements, to which the patient responded well. He is still receiving close clinical follow-up and has been in clinical remission for a period of 6 months. Figure 1 M2A capsule image of an ulcer in the proximal small bowel. Figure 2 M2A capsule image of an ulcer in the distal small bowel. Ulcerative jejunoileitis appears to be a rare complication of celiac disease [ 4 ]. However, in cases of refractory celiac disease, small-bowel radiology is often unhelpful [ 5 ] and enteroscopy is sometimes unavailable; the diagnosis often remains vague. This case highlights the usefulness of capsule endoscopy in diagnosing small-bowel diseases. The new method appears to be more helpful than classic small-bowel radiography. However, the inability to take biopsies during capsule endoscopy means that enteroscopy is still a necessary diagnostic tool. Endoscopy_UCTN_Code_CCL_1AC_2AZ

Background: Natural killer (NK) cells represent a first line of defence against a developing cancer; however, their exact role in colorectal cancer remains undetermined. The aim of the present study was to evaluate the expression of CD16 and CD57 [immunohistochemical markers of natural NK cells] in colorectal adenocarcinoma. Methods: Presence of NK cells was investigated in 82 colorectal adenocarcinomas. Immunohistochemical analysis was performed, using 2 monoclonal antibodies (anti-Fc Gamma Receptor II, CD16 and an equivalent to Leu-7, specific for CD-57). The number of immunopositive cells (%) was evaluated by image analysis. The cases were characterized according to: patient gender and age, tumor location, size, grade, bowel wall invasion, lymph node metastases and Dukes' stage. Results: NK cells were detected in 79/82 cases at the primary tumor site, 27/33 metastatic lymph nodes and 3/4 hepatic metastases; they were detected in levels similar to those reported in the literature, but their presence was not correlated to the clinical or pathological characteristics of the series, except for a negative association with the patients' age (p = 0.031). Conclusions: Our data do not support an association of NK cell tissue presence with clinical or pathological variables of colorectal adenocarcinoma, except for a negative association with the patients' age; this might possibly be attributed to decreased adhesion molecule expression in older ages.

We aimed to determine the diagnostic yield and outcome of patients receiving antithrombotic drug therapy subjected to small bowel capsule endoscopy (SBCE) for the investigation of small bowel bleeding (SBB). A multicenter retrospective analysis of collected data from all patients undergoing SBCE for the investigation of SBB from March 2003 to June 2023 was performed. The diagnostic yield of SBCE was defined as the detection of positive findings that could explain the cause of the patient’s bleeding. Rebleeding was defined as evidence of bleeding within 1 year after the index episode. During the study period, 8401 patients underwent SBCE for SBB investigation. Bleeding lesions were detected in 1103/2535 (43.5%) antithrombotic users, compared to 1113/5866 (18.9%) in nonusers (p < 0.00001). Following capsule endoscopy, a therapeutic intervention was possible in 390/2216 (17.5%) patients with a bleeding lesion. Rebleeding occurred in 927 (36.5%) of antithrombotic users (36.5%), compared to 795 (13.5%) of nonusers (13.5%, p < 0.00001). Both the diagnostic yield of SBCE and the rebleeding rates were higher in patients with SBB receiving antithrombotics. Therapeutic intervention was possible in a real-world setting only for a minority of patients with positive findings.