Efficacy of Gastrointestinal Endoscopy in 398 Patients With Iron Deficiency Anemia Who Lack Gastrointestinal Symptoms: Basrah Experience

Abstract

The diagnosis of iron deficiency anemia (IDA) relies heavily on symptom presentation, and patients lacking typical gastrointestinal (GI) symptoms represent a diagnostic challenge. IDA may be the initial manifestation of underlying pathology. This study sought to evaluate the effectiveness of different GI endoscopic studies in patients with IDA who lack GI symptoms. Methods We conducted an observational, multicenter retrospective analysis of 398 asymptomatic IDA patients admitted for GI endoscopic diagnosis from 2006 to 2016. Baseline measurements included hemoglobin, serum ferritin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation. We analyzed demographic characteristics, duration of hospital stay, the degree of severity of anemia, and endoscopic findings. Results The mean age of the study population was 52±9 years (range, 23 to 85 years), and 53% were men. Most patients were older than 45 years (n=353, 89%) with mild to moderate IDA. Patients underwent esophagogastroduodenoscopy (EGD, n=102), colonoscopy (n=271), or bidirectional endoscopy (n=25). The mean hospital stay was 2.72±1.66 days. The most common EGD results were atrophic gastritis (n=31), peptic ulcer (n=25), and negative findings (n=25). The most common colonoscopic results were negative findings (n=118), nonspecific colonic inflammatory changes (n=117), and non-bleeding hemorrhoids (n=29). We found no significant association between any endoscopic findings and age, gender, the severity of anemia, and length of hospitalization. Conclusions The presence of symptoms is of limited value in guiding diagnostic procedures concerning GI etiologies. Asymptomatic patients with IDA patients should receive an endoscopic examination irrespective of iron parameters, age, or gender for potentially treatable pathologies, especially for patients with suspected malignancies.

Do Gastrointestinal Symptoms Affect the Endoscopic Outcome in Anemic Premenopausal Women Due to Iron Deficiency: A Multicenter Study From Basrah-Iraq

“…Anemia is not uncommon and represents a unique challenge in PW. There are sparse data on IDA in PW because these patients are rarely referred for GI investigations [ 12 ], and there is no agreed-on consensus for endoscopic evaluation for asymptomatic PW [ 13 , 14 ]. Sporadic studies recommended bidirectional endoscopy (BDE) in the course of IDA evaluation of under-40-year-old PWs with IDA [ 8 , 15 , 16 ] even though significant GI pathologies were detected in published studies, with a substantial proportion of women with different GI malignancies being as high as 6% [ 5 , 7 , 8 , 17 ].…”

“…About 71% of women had different spectra of GI symptoms (n=174), while 29% lacked any GI symptoms (n=71). There was a conflicting opinion on whether the presenting GI symptoms could guide the endoscopic evaluation in PW with IDA [ 8 , 14 , 18 ]. The symptomatology might affect the chance of referral for evaluation; still, this is not the case in 29% of this cohort.…”

“…On further adjustment of the variables with the symptomatology as a dependent parameter, the power of this association was lost (Table 3 ). Many studies considered the presence of GI symptoms as an independent predictor for positive GI endoscopy, with high positive and negative predictive values, and no need to perform endoscopy in women who lack GI symptoms [ 5 , 8 , 14 , 15 , 17 ]. Vannella et al studied the pattern of symptoms and found a statistical association with the location of the GI lesions.…”

Gastrointestinal Endoscopic Outcome in Late Adolescent Women With Iron-Deficiency Anemia in Basrah-Iraq: A Multicenter Study

“…Figure 1 illustrates the process of data collection, the inclusion and exclusion criteria, and the selection of the patients for final analyses, which followed strict inclusion criteria based on Odhaib et al and Kepczyk et al [14,15]. All patients enrolled had measurements of their hemoglobin (Hb), serum ferritin, mean corpuscular volume (MCV), serum iron, total iron-binding capacity (TIBC), and transferrin saturation (TS).…”

“…Figure 1 illustrates the process of data collection, the inclusion and exclusion criteria, and the selection of the patients for final analyses, which followed strict inclusion criteria based on Odhaib et al and Kepczyk et al [ 14 , 15 ].…”