Screening for gastrointestinal malignancy in patients with iron deficiency anemia by general practitioners: An observational study

Droogendijk, Jolanda; Beukers, Ruud; Berendes, Paul; Tax, Martine G H M; Sonneveld, Pieter; Levin, Mark‐David

doi:10.3109/00365521.2011.594082

Cited by 22 publications

(28 citation statements)

References 14 publications

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“…It is worth noting that, despite advances in diagnostic technology, an accurate and complete medical history (including family history) in combination with detailed physical examination remains the most critical aspect of diagnosing GI malignancies and other serious diseases such as IBD. Taking into account evidence indicating suboptimal practices of PCPs in confronting patients with alarm features such as iron-deficient anemia,27,28 we underscore the need for complete endoscopic investigation and long-term follow-up when no cause is detected in those patients 26…”

Section: Resultsmentioning

confidence: 95%

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Gikas¹,

Triantafillidis²

2014

IJGM

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Chronic gastrointestinal disorders are a source of substantial morbidity, mortality, and cost. They are common in general practice, and the primary care physician (PCP) has a central role in the early detection and management of these problems. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. The literature review shows that, although best practice standards are available, a considerable number of PCPs do not routinely follow them. Low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors, and the fact that most PCPs are still approaching the irritable bowel disease as a diagnosis of exclusion represent the main gaps between evidence-based guidelines and clinical practice. This manuscript points out that updating of knowledge and skills of PCPs via continuing medical education is the only way for better adherence with standards and improving quality of care for patients with gastrointestinal diseases.

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Section: Resultsmentioning

confidence: 95%

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Gikas¹,

Triantafillidis²

2014

IJGM

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“…In the same vein, C-reactive protein (CRP) has been shown to be indicators of inflammation including peptic ulcers [45]. Pro-inflammatory mediators and cytokines initiate, at the site of ulcer, CRP from the liver which is a plasma protein, usually released in response to tissue inflammation.…”

Section: Discussionmentioning

confidence: 99%

Folic Acid Supplementation Ameliorates Inflammation and Apoptosis in Ethanol-Induced Gastric Ulceration in Rats

Ajeigbe¹,

Jaja²,

Onifade³

et al. 2017

JBM

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Although the gastroprotective potential of folic acid has been reported, little is known about the role of inflammation and apoptosis in the said activity. This study, therefore, assessed lipid peroxidation (LPO), Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) as markers of inflammation and, p53 and BCl-2 as markers of apoptosis in ethanol-induced gastric ulcer pretreated with Folic acid (FA) for twenty-one (21) days. Adult male Wistar rats were arranged into experimental groups (n = 5) viz: 1) Control; 2) Ulcer control; 3) 2FA (2 mg/kg folic acid + Ulcer); 4) 3FA (3 mg/kg folic acid + Ulcer); 5) OMEP (20 mg/kg omeprazole + Ulcer); 6) 2FA + OMEP + Ulcer; and 7) 3FA + OMEP + Ulcer. Ulcer score, LPO, NLR, serum CRP were all determined one hour post ulcer induction. Paraffin gastric sections were stained first with H & E, then immunostained for p53 and BCl-2. Ethanol caused gastric lesion with an index of 3.0 ± 0.2. Ulcer severity and LPO was significantly decreased in the 2FA, 3FA, OMEP, 2FA + OMEP and 3FA + OMEP groups. NLR reduced significantly in the 2FA, 3FA, OMEP and OMEP + 3FA group. Qualitatively, there was absence of C-reactive protein in the 2FA group while quantitatively, presence of CRP appeared sustained in the 3FA and OMEP treated groups. Unlike p53, the expression and labeling index of BCl-2 were significantly enhanced more in the FA and OMEP combination than OMEP alone. Folic acid ameliorates the development of gastric ulcer in rats via its anti-inflammatory and anti-apoptotic activities.

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“…Complete endoscopic investigation is recommended, since gastrointestinal cancer occurs in 10-20% of IDA patients (2)(3)(4)(5)(6)(7). Despite this recommendation, only 30-50% of patients who are diagnosed with IDA receive an endoscopic examination within 4 months (8,9). This cannot be explained as the patient's unwillingness for treatment, as it is common in daily practice for patients undergoing treatment for IDA to have received no investigation for the potential cause (10).…”

Section: Introductionmentioning

confidence: 96%

“…This cannot be explained as the patient's unwillingness for treatment, as it is common in daily practice for patients undergoing treatment for IDA to have received no investigation for the potential cause (10). Based on this data, interventions besides the aforementioned recommendation are required for a change in daily practice (8). The importance of IDA must be recognized, as IDA-associated diagnostic testing is one of the most underutilized diagnostic opportunities in colorectal cancer (11).…”

Section: Introductionmentioning

confidence: 99%

Curative resectability of gastrointestinal cancer identified from iron deficiency anemia

et al. 2017

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Abstract. The present study aimed to clarify the staging and curative resectability of gastrointestinal cancer found through iron deficiency anemia (IDA). An electronic database was used and females >51 and males >18 years old were identified who had been diagnosed with IDA at the internal medicine outpatient clinic of Asahi General Hospital (Chiba, Japan) from 1 April 2010 to 31 March 2012. IDA was defined as a hemoglobin level of <135 g/l for males and <120 g/l for females, combined with a serum ferritin level of <33.71 pmol/l. Of the 472 patients who had been diagnosed with IDA, 347 patients underwent either a gastroscopy and/or colonoscopy, including 120 patients who had undergone both gastroscopy and colonoscopy, 197 patients who only underwent gastroscopy, and 30 patients who only underwent colonoscopy. In total, 125/472 patients diagnosed with IDA did not undergo a gastroscopy or a colonoscopy. From the 50 patients who were diagnosed with cancer as a result of the investigation, 24 patients had gastric cancer and 23 patients had colorectal cancer. Of the gastric cancer patients, 6 patients were stage I, 3 patients stage II, 5 patients were stage III and 9 patients were stage IV. In colorectal cancer, 9 patients were stage II, 8 patients were stage III and 4 patients were stage IV. Curative surgery including endoscopic treatment was performed on 14 gastric cancer patients and 17 colorectal cancer patients of stage III or lower. Malignancies were found in 50 patients with IDA, and curative surgery was performed on >50% of the patients.

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Screening for gastrointestinal malignancy in patients with iron deficiency anemia by general practitioners: An observational study

Abstract: In our retrospective study of patients with IDA, only 31% received any form of endoscopic evaluation. In general practice, IDA is investigated suboptimally, and interventions other than the issuing of guidelines are needed to change practice.

Cited by 22 publications

References 14 publications

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Folic Acid Supplementation Ameliorates Inflammation and Apoptosis in Ethanol-Induced Gastric Ulceration in Rats

Curative resectability of gastrointestinal cancer identified from iron deficiency anemia

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