AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

Rockey, Don C.; Altayar, Osama; Falck‐Ytter, Yngve; Kalmaz, Denise

doi:10.1053/j.gastro.2020.06.045

Cited by 37 publications

(57 citation statements)

References 119 publications

(172 reference statements)

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“…They found that celastrol suppresses food intake, increases energy expenditure, and reduces body weight up to 45% in hyperleptinemic DIO mice ( 161 ). Although celastrol’s molecular mechanism regulates leptin sensitivity remains obscure, it was found that celastrol mediates leptin sensitization and exerts anti-obesity effects through increasing interleukin-1 receptor 1 (IL1R1) expression in the hypothalamus ( 173 ). Furthermore, celastrol promotes leptin sensitivity through inhibition of 6-phosphofructokinase (PFK) in skeletal muscle and activation of adenosine 5’monophosphate-activated protein kinase (AMPK), which leads to alterations in energy demand from glycolysis to the free fatty acid oxidation in skeletal muscle and increases energy expenditure ( 174 ).…”

Section: Leptin and Obesitymentioning

confidence: 99%

Leptin and Obesity: Role and Clinical Implication

et al. 2021

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The peptide hormone leptin regulates food intake, body mass, and reproductive function and plays a role in fetal growth, proinflammatory immune responses, angiogenesis and lipolysis. Leptin is a product of the obese (ob) gene and, following synthesis and secretion from fat cells in white adipose tissue, binds to and activates its cognate receptor, the leptin receptor (LEP-R). LEP-R distribution facilitates leptin’s pleiotropic effects, playing a crucial role in regulating body mass via a negative feedback mechanism between adipose tissue and the hypothalamus. Leptin resistance is characterized by reduced satiety, over-consumption of nutrients, and increased total body mass. Often this leads to obesity, which reduces the effectiveness of using exogenous leptin as a therapeutic agent. Thus, combining leptin therapies with leptin sensitizers may help overcome such resistance and, consequently, obesity. This review examines recent data obtained from human and animal studies related to leptin, its role in obesity, and its usefulness in obesity treatment.

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Section: Leptin and Obesitymentioning

confidence: 99%

Leptin and Obesity: Role and Clinical Implication

et al. 2021

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“…Therefore, our technical review and recommendations focused on appropriate gastrointestinal evaluation in this patient population. 5 As described in detail in the technical review accompanying this guideline, extensive searches of multiple reference databases were undertaken to identify available evidence to inform our recommendations, and the quality of the evidence was systematically assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. 5 We agree entirely that understanding mechanisms of iron homeostasis is important and often helps direct the evaluation and management of IDA.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

“…5 As described in detail in the technical review accompanying this guideline, extensive searches of multiple reference databases were undertaken to identify available evidence to inform our recommendations, and the quality of the evidence was systematically assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. 5 We agree entirely that understanding mechanisms of iron homeostasis is important and often helps direct the evaluation and management of IDA. These mechanisms were covered in the accompanying technical review, including discussion specifically of divalent metal transporter-1, in both the text and in Figure 1 of the technical review.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

“…These mechanisms were covered in the accompanying technical review, including discussion specifically of divalent metal transporter-1, in both the text and in Figure 1 of the technical review. 5 Drs Kaunitz and Ganz raised specific concerns about the selection of a ferritin cutoff value of <45 ng/mL, instead of <15 ng/mL, for the diagnosis of IDA. We agree this is a critical consideration, and therefore the technical review panel spent considerable effort examining the data relating to this specific topic in preparing the evidence synthesis and technical review.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

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Siddique

Patel

et al. 2021

Gastroenterology

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The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review. Am J Clin Nutr 2017;106(Suppl 6):1688s-1693s. 14. Smith MD, Pannacciulli IM. Absorption of inorganic iron from graded doses: its significance in relation to iron absorption tests and mucosal block theory. Br J Haematol 1958;4:428-434. 15. Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.

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“…Guidelines produced by The British Society of Gastroenterology (BSG) suggest the use of bidirectional endoscopy to investigate these groups ( 3 ) and more recent guidance published by the American Gastroenterology Association also includes pre-menopausal women with asymptomatic IDA ( 4 ). Bidirectional endoscopy in post-menopausal women and men will reveal upper gastrointestinal (GI) malignancy in 2% and lower GI malignancy in 8.9% ( 5 ). The investigation of patients with iron deficiency without anaemia (IDWA) is not generally recommended by guidelines because it is thought that the overall risk of GI cancer is low in this patient group iron deficiency without anaemia (IDWA) ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

The Value of Quantitative Faecal Immunochemical Testing as a Prioritisation Tool for the Endoscopic Investigation of Patients With Iron Deficiency

2021

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Difficulty in providing endoscopy for patients with iron deficiency anaemia (IDA) during the COVID-19 pandemic has highlighted the requirement for a prioritisation tool. We aimed to test the validity of qFIT as a prioritisation tool in patients with iron deficiency and its ability to identify patients with advanced neoplastic lesions (ANLs). Data collected from patients referred with biochemically proven iron deficiency (ferritin ≤ 15 μg/L) and synchronous qFIT who underwent full gastrointestinal investigation within NHS Greater Glasgow and Clyde was analysed retrospectively. Patients who did not undergo full investigation, defined as gastroscopy and colonoscopy or CT colonography, were excluded. ANLs were defined as defined as upper GI cancer, colorectal adenoma ≥ 1 cm or colorectal cancer. Area under the curve (AUC) analysis was performed on qFIT results and outcome, defined as the presence of an ANL. AUC analysis guided cut-off scores for qFIT. Patients with a qFIT of <10, 10–200, >200, were allocated a score of 1, 2, and 3, respectively. A total of 575 patients met criteria for inclusion into the study. Overall, qFIT results strongly predicted the presence of ANLs (AUC 0.87, CI 0.81–0.92; P < 0.001). The prevalence of ANLs in patients with scores 1–3 was 1.2, 13.5, and 38.9% respectfully. When controlled for other significant variables, patients with a higher qFIT score were statistically more likely to have an ANL (qFIT score = 2; OR 12.8; P < 0.001, qFIT score = 3, OR 50.0; P < 0.001). A negative qFIT had a high NPV for the presence of ANLs (98.8%, CI 97.0–99.5%). These results strongly suggest that qFIT has validity as a prioritisation tool in patients with iron deficiency; both allowing for a more informed decision of investigation of patients with very low risk of malignancy, and in identifying higher risk patients who may benefit from more urgent endoscopy.

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AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

Cited by 37 publications

References 119 publications

Leptin and Obesity: Role and Clinical Implication

Leptin and Obesity: Role and Clinical Implication

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The Value of Quantitative Faecal Immunochemical Testing as a Prioritisation Tool for the Endoscopic Investigation of Patients With Iron Deficiency

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