Digestive Diseases and Sciences

, Volume 58, Issue 2, pp 488–495 | Cite as

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


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.


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


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.


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.


Iron deficiency anemia Colonoscopy Endoscopy Colorectal cancer 



This work was supported in part by NIH#DK090506 (SBH). Additional resources were provided by the Research Service, VA San Diego Healthcare System, San Diego, CA.

Conflict of interest



  1. 1.
    Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med. 1993;329:1691–1695.PubMedCrossRefGoogle Scholar
  2. 2.
    Kepczyk MT, Kadakia CS. Prospective evaluation of gastrointestinal tract in patients with iron deficiency anemia. Dig Dis Sci. 1995;40:1283–1289.PubMedCrossRefGoogle Scholar
  3. 3.
    McIntyre AS, Long RG. Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut. 1993;34:1102–1107.PubMedCrossRefGoogle Scholar
  4. 4.
    Gordon SR, Smith RE, Power GC. The role of endoscopy in the evaluation of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol. 1994;89:1963–1967.PubMedGoogle Scholar
  5. 5.
    Goddard AF, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. Gut 2000;46:IV1–IV5.Google Scholar
  6. 6.
    Sahay R, Scott BB. Iron deficiency anaemia—how far to investigate? Gut. 1993;34:1427–1428.PubMedCrossRefGoogle Scholar
  7. 7.
    Gordon S, Bensen S, Smith R. Long-term follow-up of older patients with iron deficiency anemia after a negative GI evaluation. Am J Gastroenterol. 1996;91:885–889.PubMedGoogle Scholar
  8. 8.
    McLoughlin MT, Tham TC. Long-term follow-up of patients with iron deficiency anaemia after a negative gastrointestinal evaluation. Eur J Gastroenterol Hepatol. 2009;21:872–876.PubMedCrossRefGoogle Scholar
  9. 9.
    Chao HH, Schwartz AR, Hersh J, et al. Improving colorectal cancer screening and care in the Veterans Affairs Healthcare system. Clin Colorectal Cancer. 2009;8:22–28.PubMedCrossRefGoogle Scholar
  10. 10.
    Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at veterans affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000;160:3252–3257.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.PubMedCrossRefGoogle Scholar
  12. 12.
    Lee RH, Tang RS, Muthusamy VR, et al. Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos). Gastrointest Endosc. 2011;74:128–134.PubMedCrossRefGoogle Scholar
  13. 13.
    Kilgore TW, Abdinoor AA, Szary NM, et al. Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc. 2011;73:1240–1245.PubMedCrossRefGoogle Scholar
  14. 14.
    Moch A, Herlinger H, Kochman ML, et al. Enteroclysis in the evaluation of obscure gastrointestinal bleeding. AJR Am J Roentgenol. 1994;163:1381–1384.PubMedGoogle Scholar
  15. 15.
    Apostolopoulos P, Liatsos C, Gralnek IM, et al. The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. Endoscopy. 2006;38:1127–1132.PubMedCrossRefGoogle Scholar
  16. 16.
    Sheibani S, Levesque BG, Friedland S, et al. Long-term impact of capsule endoscopy in patients referred for iron-deficiency anemia. Dig Dis Sci. 2010;55:703–708.PubMedCrossRefGoogle Scholar
  17. 17.
    Milano A, Balatsinou C, Filippone A, et al. A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis. Gastrointest Endosc. 2011;73:1002–1008.PubMedCrossRefGoogle Scholar

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

Personalised recommendations