Cutoff values of serum ferritin and TIBC saturation for the evaluation of gastrointestinal neoplasms in adult anemic patients

Lee, Mark Hong; Park, Eugene; Lee, Jong-Chan; Kim, So Young; Kim, Sung Yong; Lee, Sun Young; Cho, Yo Han; Yoon, So Young

doi:10.1007/s12185-012-1129-3

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…We finish by stating that because the primary goal of guidelines creation is the alteration of clinical practice with the intention of reducing disease, these and all similar guidelines ultimately should be subject to clinical trials aimed at testing whether the guidelines governing indications for endoscopy based on iron biomarkers effectively identify patients with treatable GI lesions, as has been demonstrated in the past. 27,28 We look forward to improvement of health based on such considerations and thank you again for not only publishing these guidelines but also for welcoming letters such as ours. Correspondence Gastroenterology Vol.…”

Section: Final Commentsmentioning

confidence: 99%

AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

Kaunitz

Ganz

2021

Gastroenterology

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This letter is in response to the recently AGA Clinical Practice Guidelines regarding the gastrointestinal evaluation of iron deficiency anemia (IDA). 1 We thank the editors of Gastroenterology for compiling such complete and well researched guidelines regarding the diagnosis, treatment, and testing for IDA. In particular, the recommendations regarding the management of patients with negative bidirectional endoscopy with occult bleeding should decrease the number of unnecessary procedures performed for this indication. We would like to offer comments on two of the proposed guidelines, as follows.

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Section: Final Commentsmentioning

confidence: 99%

AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

Kaunitz

Ganz

2021

Gastroenterology

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“…Gastroenterology guidelines insist on upper and lower GI endoscopic workup in patients with iron-deficient anaemia to detect potential malignancies and in all male patients and in post-menopausal women. 10,[15][16][17][18] In these patients, an underlying GI malignancy often (10-15%) contributes to the state of iron deficiency. 10 Indeed, cohort studies, in the gastroenterology literature, suggest that the prevalence of underlying malignancies is lower in patients with iron deficiency without anaemia.…”

Section: Gi Malignancy and Which Patients Really Need An Endoscopic mentioning

confidence: 99%

“…Of the 1191 patients, a total of 699 (59%) patients underwent a full endoscopic GI workup, during a mean follow-up of 50 ± 27 months. The median time between entry into the database (with lab testing) to endoscopy was 9 (inter-quartile range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19] months. Therefore, the final study population constituted 699 patients.…”

Section: Study Population and Endoscopic Workupmentioning

confidence: 99%

“…Gastroenterology literature often uses a ferritin level cutoff < 15-30 μg/L (in the absence of inflammation) to define a state of (absolute) iron deficiency. 10,[15][16][17][18] In these patients, an underlying GI malignancy often (10-15%) contributes to the state of iron deficiency. 10 However, the heart failure syndrome itself is a pro-inflammatory disease.…”

Section: Gi Malignancy and Which Patients Really Need An Endoscopic mentioning

confidence: 99%

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Prevalence of underlying gastrointestinal malignancies in iron‐deficient heart failure

et al. 2018

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AimsAnaemia and iron deficiency (ferritin level < 100 or 100–300 μg/L with transferrin saturation < 20%) are prevalent in heart failure. Mechanistically, iron deficiency is linked to poor intestinal uptake, increased intestinal loss, and chronic inflammation. However, the prevalence of underlying gastrointestinal malignancies is not established in iron‐deficient heart failure with or without anaemia.Methods and resultsPatients followed up in a single‐centre, heart failure database with baseline registration of haemoglobin and iron status were retrospectively evaluated. The proportion of patients undergoing upper and lower gastrointestinal endoscopy between inclusion and censoring was determined. Afterwards, the prevalence of biopsy that confirmed intestinal malignancies in relation to baseline iron and haemoglobin status was determined. Anaemia was defined as a haemoglobin level <12 g/dL, and iron deficiency according to the aforementioned criteria. Of the 1197 patients in the database, 699 (59%) patients underwent full endoscopic workup over a mean follow‐up of 50 ± 27 months. A total of 50 intestinal malignancies were identified (n = 42, 84%, in iron‐deficient vs. n = 8, 16%, non‐iron‐deficient patients; P < 0.001). The prevalence of intestinal malignancies was non‐statistically different in iron‐deficient patients with anaemia (n = 12/129, 9.3%) or without anaemia (n = 30/287, 10.5%; P = 0.551). The prevalence was much lower in patients without iron deficiency with anaemia (n = 5/83, 6%) or without anaemia (n = 3/200, 1.5%). In patients with iron deficiency but without anaemia (a group in which the role of endoscopic workup is less established), ferritin levels carried an inverse diagnostic capacity in detecting patients with an underlying malignancy (area under the curve = 0.741, P < 0.001). A ferritin level < 56 μg/L had the best acuity, detecting malignancies with a sensitivity of 80% and a specificity of 71%.ConclusionsEndoscopic evaluation is warranted in heart failure patients with iron‐deficient anaemia given the high prevalence of underlying intestinal malignancies, as advised by gastroenterology guidelines. However, additional research is needed assessing the best approach to patients with iron deficiency without anaemia, given the high occurrence of intestinal malignancies in these patients. A lower ferritin level could potentially help stratify the need for an endoscopic workup in these patients.

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A novel low molecular weight Enteromorpha polysaccharide-iron (III) complex and its effect on rats with iron deficiency anemia (IDA)

Cui

et al. 2018

International Journal of Biological Macromolecules

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Cutoff values of serum ferritin and TIBC saturation for the evaluation of gastrointestinal neoplasms in adult anemic patients

Cited by 3 publications

References 24 publications

AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

Prevalence of underlying gastrointestinal malignancies in iron‐deficient heart failure

A novel low molecular weight Enteromorpha polysaccharide-iron (III) complex and its effect on rats with iron deficiency anemia (IDA)

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