Digestive Diseases and Sciences

, Volume 51, Issue 12, pp 2372–2376 | Cite as

Significance of Endoscopy in Asymptomatic Premenopausal Women with Iron Deficiency Anemia

  • Dong Il Park
  • Seung Ho Ryu
  • Suk Joong Oh
  • Tae Woo Yoo
  • Hong Ju Kim
  • Yong Kyun Cho
  • In Kyung Sung
  • Chong Il Sohn
  • Woo Kyu Jeon
  • Byung Ik Kim
Original Paper


There is, currently, no consensus with regard to the role of endoscopy in the etiologic investigation of asymptomatic pemenopausal women suffering from iron deficiency anemia (IDA). We conducted a retrospective case-control study to evaluate the contribution of esophagogastroduodenoscopy (EGD) and colonoscopy to the etiologic diagnosis of a group of asymptomatic premenopausal women suffering from IDA. One hundred eight consecutive asymptomatic premenopausal women who fulfilled our entry criteria were included in our patient group between January 1998 and December 2004. One hundred thirty-five age-matched asymptomatic premenopausal women without anemia who had undergone EGD and colonoscopy for medical checkups were included in the control group. Clinically relevant lesions were detected in 7 of 108 (6.5%) of the patients and in 8 of 135 (5.9%) of the controls. There were no differences with regard to the frequency of clinically relevant lesions between the two groups (P > 0.05). Concomitant upper and lower GI lesions were not detected in any patients. In the upper GI tract, the only lesion found to be potentially causative of IDA anemia was a severe erosive gastritis, which was found in both the patient and the control groups. A source consistent with chronic bleeding was detected in the lower GI tract in 6 (5.6%) of the patients and 7 (5.2%) of the controls. Bleeding hemorrhoids represented the most frequently detected lesions in both the patient and control groups. Only one case of colon cancer was detected in the patient group. As IDA in the premenopausal women could not be attributed consistently to GI blood loss in this study, prospective studies should be conducted to validate our findings and to identify which subgroup of asymptomatic premenopausal women would benefit from a diagnostic endoscopic evaluation.


Anemia Iron deficiency Premenopause Esophagogastroduodenoscopy Colonoscopy 


  1. 1.
    Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL (1997) Prevalence of iron deficiency in the United States. JAMA 277:973–976CrossRefPubMedGoogle Scholar
  2. 2.
    Kim SK, Kim CS, Choi JW, Cho MH, Kim KH, Chang KJ (2003) Iron status in adolescent female athletes. Korean J Hematol 38:240–245Google Scholar
  3. 3.
    Rockey DC (1999) Occult gastrointestinal bleeding. N Engl J Med 341:38–46CrossRefPubMedGoogle Scholar
  4. 4.
    Rockey DC, Cello JP (1993) Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 329:1691–1695CrossRefPubMedGoogle Scholar
  5. 5.
    Kepczyk T, Kadakia SC (1995) Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Dig Dis Sci 40:1283–1289CrossRefPubMedGoogle Scholar
  6. 6.
    Bampton PA, Holloway RH (1996) A prospective study of the gastroenterological causes of iron deficiency anemia in a general hospital. Aust NZ J Med 26:793–799Google Scholar
  7. 7.
    Cook IJ, Pavli P, Riley JW, Goulston KJ, Dent OF (1986) Gastrointestinal investigation of iron deficiency anemia. Br Med J 292:1380–1382CrossRefGoogle Scholar
  8. 8.
    Wilcox CM, Alexander LN, Clark WS (1997) Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs. Am J Med 103:405–409CrossRefPubMedGoogle Scholar
  9. 9.
    Gordon SR, Smith RE, Power GC (1994) The role of endoscopy in the evaluation of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol 89:1963–1967PubMedGoogle Scholar
  10. 10.
    Hardwick RH, Armstrong CP (1997) Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anemia. Br J Surg 84:1725–1728CrossRefPubMedGoogle Scholar
  11. 11.
    Bini EJ, Micale PL, Weinshel EH (1998) Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia. Am J Med 105:281–286CrossRefPubMedGoogle Scholar
  12. 12.
    Till SH, Grundman MJ (1997) Prevalence of concomitant disease in patients with iron deficiency anemia. Br Med J 314:206–208Google Scholar
  13. 13.
    Lee JG, Sahagun G, Oehlke MA, Lieberman DA (1998) Serious gastrointestinal pathology found in patients with serum ferritin values ≤50 ng/ml. Am J Gastroentorol 93:772–776Google Scholar
  14. 14.
    Nahon S, Lahmek P, Lesgourgues B, et al. (2002) Predictive factors of GI lesions in 241 women with iron deficiency anemia. Am J Gastroenterol 97:590–593CrossRefPubMedGoogle Scholar
  15. 15.
    Green BT, Rockey DC (2004) Gastrointestinal endoscopic evaluation of premenopausal women with iron deficiency anemia. J Clin Gastroenterol 38:104–109CrossRefPubMedGoogle Scholar
  16. 16.
    Guyatt GH, Patterson C, Ali M, Singer J, Levine M, Turpie I, Meyer R (1990) Diagnosis of iron-deficiency anemia in the elderly. Am J Med 88:205–209CrossRefPubMedGoogle Scholar
  17. 17.
    McIntyre AS, Long RG (1993) Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut 34:1102–1107PubMedGoogle Scholar
  18. 18.
    Smieja MJ, Cook DJ, Hunt DL, Ali MA, Guyatt GH (1996) Recognizing and investigating iron-deficiency anemia in hospitalized elderly people. CMAJ 155:691–696PubMedGoogle Scholar
  19. 19.
    Braveman PA, Tarimo E (1994) In: Screening in primary health care: Setting priorities with limited resources, 1st ed. World Health Organization, GenevaGoogle Scholar
  20. 20.
    Kitai E, Kaplan B, Raick Y, Cohen Y, Neri A, Friedman J (1996) Community screening to reveal iron deficiency in healthy menstruating women in Israelian suburbs. Eur J Obstet Gynecol Reprod Biol 67:21–25CrossRefPubMedGoogle Scholar
  21. 21.
    Annibale B, Capurso G, Chistolini A, D’Ambra G, DiGiulio E, Monarca B, DelleFave G (2001) Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms. Am J Med 111:439–445CrossRefPubMedGoogle Scholar
  22. 22.
    Schottenfeld D (1981) The epidemiology of cancer: an overview. Cancer 47(Suppl 5):1095–1108CrossRefPubMedGoogle Scholar
  23. 23.
    Kassarjian Z, Russell RM (1989) Hypochlorhydria: a factor in nutrition. Annu Rev Nutr 9:271–285CrossRefPubMedGoogle Scholar
  24. 24.
    Dickey W, Kenny BD, McMillan SA, Porter KG, McConnell JB (1997) Gastric as well as duodenal biopsies may be useful in the investigation of iron deficiency anaemia. Scand J Gastroenterol 32:469–472PubMedGoogle Scholar
  25. 25.
    Marignani M, Delle Fave G, Mecarocci S, Bordi C, Angeletti S, D’Ambra G, Aprile MR, Corleto VD, Monarca B, Annibale B (1999) High prevalence of atrophic body gastritis in patients with unexplained microcytic and macrocytic anemia. Am J Gastroenterol 94:766–772PubMedGoogle Scholar
  26. 26.
    Annibale B, Marignani M, Monarca B, Antonelli G, Marcheggiano A, Martino G, Mandelli F, Caprilli R, Delle Fave G (1999) Reversal of iron deficiency anemia after Helicobacter pylori eradication in patients with asymptomatic gastritis. Ann Intern Med 131:668–672PubMedGoogle Scholar
  27. 27.
    Choe YH, Kim SK, Son BK, Lee DH, Hong YC, Pai SH (1999) Randomized placebo-controlled trial of Helicobacter pylori eradication for iron-deficiency anemia in preadolescent children and adolescents. Helicobacter 4:135–139CrossRefPubMedGoogle Scholar
  28. 28.
    Annibale B, Capurso G, Martino G, Grossi C, Delle Fave G (2000) Iron deficiency anemia and Helicobacter pylori infection. Int J Antimicrob Agents 16:515–519CrossRefPubMedGoogle Scholar
  29. 29.
    Capurso G, Marignani M, Delle Fave G, Annibale B (1999) Iron deficiency anemia in premenopausal women: Why not consider atrophic body gastritis and Helicobacter pylori role? Am J Gastroenterol 94:3084–3085CrossRefPubMedGoogle Scholar
  30. 30.
    Annibale B, Severi C, Chistolini A, Antonelli G, Lahner E, Marcheggiano A, Iannoni C, Monarca B, Delle Fave G (2001) Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol 96:132–137CrossRefPubMedGoogle Scholar
  31. 31.
    Goddard AF, McIntyre AS, Scott BB, Goddard WP, Long RG (1999) Iron-deficiency anaemia in premenopausal women. Lancet 353:1014–1015CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  • Dong Il Park
    • 1
  • Seung Ho Ryu
    • 2
  • Suk Joong Oh
    • 1
  • Tae Woo Yoo
    • 1
  • Hong Ju Kim
    • 1
  • Yong Kyun Cho
    • 1
  • In Kyung Sung
    • 1
  • Chong Il Sohn
    • 3
  • Woo Kyu Jeon
    • 1
  • Byung Ik Kim
    • 1
  1. 1.Department of MedicineKangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulKorea
  2. 2.Department of Occupational MedicineKangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulKorea
  3. 3.Division of GastroenterologyDepartment of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulKorea 110-746

Personalised recommendations