Original ArticlesCan patient characteristics predict the outcome of endoscopic evaluation of iron deficiency anemia: a multiple logistic regression analysis
Section snippets
Patients and methods
Ambulatory patients referred from a university hematology department for evaluation of unexplained IDA from November 1999 to June 2001, according to established protocols,10., 11., 12., 13. were included in the study. Iron deficiency anemia was defined as a Hb level less than 14 g/L for men and less than 12 g/L for women, together with a plasma ferritin of less than 30 μg/L and a mean corpuscular volume (MCV) of less than 80 fL. Exclusion criteria, previously reported,10., 11., 12., 13. for
GI findings
At least one finding likely to cause IDA was detected in 85 (86.7%) of the 98 patients; 8 patients had two concomitant likely causes (Table 1). A likely bleeding site was identified by EGD in 20 patients (20%). Peptic ulcer was the most common lesion, being found in 9 patients (all H pylori positive). Gastric cancer was found in 5 patients. A large hiatal hernia with Cameron's erosions was found in 7 patients.
Endoscopic/histolopathologic evaluation revealed possible non-bleeding causes of iron
Discussion
Age greater than 50 years, male gender, and MCV less than 70 fL were strongly associated with GI malignancy in either the upper- or the lower-GI tract in the present study. These findings are in agreement with the observed higher risk of malignancy in elderly men.20 Given that the incidence of colorectal cancer is higher than that for gastric cancer,21 these results suggest that colonoscopy should be performed first in patients with IDA who are over 50 years of age, followed by EGD.
References (24)
- et al.
High prevalence of atrophic body gastritis in patients with unexplained microcytic and macrocytic anemia
Am J Gastroenterol
(1999) - et al.
Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients
Am J Gastroenterol
(2001) - et al.
Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms
Am J Med
(2001) - et al.
AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding
Gastroenterology
(2000) - et al.
The stomach and iron deficiency anaemia: a forgotten link
Dig Liver Dis
(2003) - et al.
Role of small bowel investigation in iron deficiency anemia after negative endoscopic/histologic evaluation of the upper and lower gastrointestinal tract
Dig Liver Dis
(2003) - et al.
Logistic regression
Gastrointest Endosc
(2002) - et al.
Iron deficiency and gastrointestinal malignancy: a population-based cohort study
Am J Med
(2002) - et al.
A comparative analysis of cancer prevalence in cancer registry areas of France, Italy and Spain
Ann Oncol
(2002) - et al.
Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient
Am J Med
(1999)
Serious gastrointestinal pathology found in patients with serum ferritin values ≤50 ng/ ml
Am J Gastroenterol
Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia
Am J Med
Cited by (42)
AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia
2020, GastroenterologyCitation Excerpt :The pooled prevalence was 10.1% (95% CI, 7.6%–12.8%). Although establishing a diagnosis of autoimmune atrophic gastritis may prevent further evaluation and may direct iron repletion therapy in the patient with established atrophic gastritis, the certainty of evidence that the benefits of identifying atrophic gastritis outweighs the harms was very low due to indirectness of evidence, high risk of bias (selection bias), and inconsistency (different inclusion criteria and workup approach).51,90–94 In conclusion, in patients with IDA, the Review Panel did not find enough evidence that benefits of random gastric biopsies or noninvasive testing to diagnose atrophic body gastritis would outweigh potential harms.
A comprehensive evaluation of the gastrointestinal tract in iron-deficiency anemia with predefined hemoglobin below 9 mg/dL: A prospective cohort study
2017, Digestive and Liver DiseaseCitation Excerpt :In addition, APs more frequently presented ulcerated/friable cancer lesions and diffuse angiodysplastic lesions as well as a higher number of lesions in each GI segment than NAPs. The endoscopic findings in NAPs were, in fact, similar to those reported in adults undergoing investigation for IDA in other developed countries [2–4,6,9,12,29]. The greater use of NSAIDs in NAPs could also contribute to the higher occurrence of upper ulcerative/erosive lesions in these patients [1,6].
Colonoscopy Identifies Increased Prevalence of Large Polyps or Tumors in Patients 40-49 Years Old With Hematochezia vs Other Gastrointestinal Indications
2016, Clinical Gastroenterology and HepatologyCitation Excerpt :Common findings included celiac disease, Helicobacter pylori, and gastritis. The investigators suggested that patients with iron-deficiency anemia be evaluated initially with upper endoscopy before lower endoscopy, given the higher prevalence of upper GI findings.14 On the other hand, Bini et al15 evaluated the GI tract of 186 premenopausal women with iron-deficiency anemia and found a clinically important upper or lower gastrointestinal lesion in 12% of patients, with 5% of patients having either colon cancer or a polyp larger than 2 cm, suggesting that endoscopy yields important findings in this population.
Faecal occult blood test and iron deficiency anaemia
2012, Digestive and Liver DiseaseIs faecal-immunochemical test useful in patients with iron deficiency anaemia and without overt bleeding?
2011, Digestive and Liver DiseaseCitation Excerpt :Potential causes of colorectal bleeding included: cancer, one or more polyps (>1.5 cm in diameter), 5 or more vascular ectasias or a vascular ectasia >5 mm in size, and histologically proven inflammatory bowel disease [10–14]. Non-bleeding causes of IDA included celiac disease and atrophic gastritis involving the body of the stomach, both documented at histology [10–12]. IDA-patients with normal findings at both upper endoscopy and colonoscopy but with FIT positivity were invited to perform a small bowel capsule endoscopy.