Digestive Diseases and Sciences

, Volume 58, Issue 2, pp 488–495

Long-Term Outcomes and Prognostic Factors for Patients with Endoscopy-Negative Iron Deficiency

  • Anny Soon
  • Benjamin L. Cohen
  • Erik J. Groessl
  • Samuel B. Ho
Original Article

DOI: 10.1007/s10620-012-2368-0

Cite this article as:
Soon, A., Cohen, B.L., Groessl, E.J. et al. Dig Dis Sci (2013) 58: 488. doi:10.1007/s10620-012-2368-0

Abstract

Background and Aim

Iron deficiency anemia (IDA) is a common problem among the elderly, and often no cause is identified after routine upper endoscopy and colonoscopy exams. The purpose of this study was to determine the long-term outcomes and predictors of gastrointestinal pathology and death in patients with endoscopy-negative IDA.

Methods

This was a retrospective review of consecutive endoscopy negative-IDA patients during 2002–2004 at the VA San Diego Healthcare System.

Results

Mean age was 69.3 years (range 42–93), and included 105 men and nine women. Mean length of follow-up was 65.1 months. IDA resolved in 56 patients. None of these patients developed evidence of any clinically significant gastrointestinal pathology. The remaining 58 patients had persistent anemia (n = 47) or recurrent anemia (n = 11). Only 2/47 patients with persistent anemia were found to have clinically significant but benign gastrointestinal pathology during follow-up. In contrast, 6/11 patients with recurrent anemia were subsequently found to have gastrointestinal pathology. Deaths during follow-up occurred in 7 (12.5 %) patients with resolved anemia, compared with 20 (34.5 %) patients with recurrent or persistent anemia (p = 0.006). Significant independent predictors of death included persistent or recurrent anemia, anti-platelet or anticoagulant use, and congestive heart failure.

Conclusions

Patients with iron deficiency anemia and negative upper endoscopy and colonoscopy often have a favorable outcome, especially if the anemia resolves with treatment. In patients with recurrent anemia a malignancy within reach of standard endoscopy and colonoscopy are possible, and repeating these procedures is warranted before consideration of further investigations.

Keywords

Iron deficiency anemiaColonoscopyEndoscopyColorectal cancer

Copyright information

© Springer Science+Business Media, LLC (Outside the USA) 2012

Authors and Affiliations

  • Anny Soon
    • 1
  • Benjamin L. Cohen
    • 1
  • Erik J. Groessl
    • 2
  • Samuel B. Ho
    • 1
  1. 1.Department of Medicine, Gastroenterology (111D)VA San Diego Healthcare System and University of California, San DiegoSan DiegoUSA
  2. 2.Department of Family and Preventative MedicineVA San Diego Healthcare System and University of California, San DiegoSan DiegoUSA