Chronic Enteropathy Associated with SLCO2AI in a Patient with Anemia Detected on Incidental Screening

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  A 74-year-old woman with a history of non-steroidal anti-inflammatory drug (NSAID) use for knee osteoarthritis was diagnosed with anemia during a Japanese comprehensive health check-up. Anemia was detected for 3 consecutive years but was left untreated as she was asymptomatic. She was referred to our hospital for workup of chronic anemia and pedal edema. A gastric ulcer and multiple intestinal ulcers were identified on upper gastrointestinal and capsule endoscopies. She was initially diagnosed with NSAID-induced gastric and intestinal ulcers and we discontinued NSAID therapy. This resulted in an improvement in the gastric ulcer but not the small intestinal ulcers. On further questioning, she reported a family history of consanguineous marriage. The patient underwent further investigations including genetic testing and a transanal double-balloon enteroscopy and was finally diagnosed with chronic enteropathy associated with SLCO2AI (CEAS). In this study, we report a case of CEAS diagnosed in a patient with anemia detected incidentally during routine screening which was differentiated from drug-induced small intestinal mucosal injury after additional investigations.