Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia

Abstract

Gastrointestinal bleeding is believed to cause iron-deficiency anemia (IDA). The information concerning ideal evaluation of the gastrointestinal tract and exact findings in patients with IDA is scant. The aim of this study was to prospectively evaluate patients with IDA for gastrointestinal lesions potentially causing IDA at a US Army Teaching Medical Center with Gastroenterology Fellowship. Seventy patients with IDA had esophagogastroduodenoscopy (EGD) and colonoscopy, and if this evaluation was unremarkable, then small bowel biopsy was obtained at EGD to evaluate for celiac disease. Enteroclysis was done if endoscopic evaluation was negative. At endoscopy, at least one lesion potentially accounted for the IDA in 50 (71%) patients. At colonoscopy, 21 (30%) patients had 22 lesions (four colon cancer, seven adenoma>1 cm, six vascular malformation, four severely bleeding hemorrhoids, one ileal Crohn's); at EGD, 39 (56%) patients had 43 lesions (11 gastric erosion, 10 esophagitis, four vascular malformation, four celiac disease, three gastric cancer, three gastric ulcer, three duodenal ulcer, two gastric polyp>1 cm, one duodenal lymphoma, one esophageal cancer, and one duodenal Crohn's). Twelve (17%) patients had both upper and lower gastrointestinal tract lesions. Twenty-four of 32 (75%) patients with positive fecal occult blood test had potentially bleeding lesions compared to 24 of 38 (63%) patients with negative fecal occult blood test (P>0.05). Six of nine patients with malignancy had positive fecal occult blood test. Twenty patients with normal endoscopy and small bowel biopsy had normal enteroclysis. It is concluded that the combination of colonoscopy and EGD identifies potential bleeding sources in most patients with IDA. In the absence of a potential bleeding lesion, small bowel biopsy at EGD is essential to diagnose celiac disease.

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References

  1. 1.

    Calvey HD, Castleden CM: Gastrointestinal investigations for anaemia in the elderly: A prospective study. Age Ageing 16:399–404, 1987

    PubMed  Google Scholar 

  2. 2.

    Wroblewski M, Ostberg H: Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Scand J Gastroenterol 25:489–495, 1990

    PubMed  Google Scholar 

  3. 3.

    Guyatt GH, Patterson C, Ali M, Singer JS, Levine M, Turpie I, Meyer R: Diagnosis of iron-deficiency anemia in the elderly. Am J Med 88:205–209, 1990

    PubMed  Google Scholar 

  4. 4.

    Walsh JR, Cassel CK, Madler JJ: Iron deficiency in the elderly: It's often nondietary. Geriatrics 36:121–132, 1981

    Google Scholar 

  5. 5.

    Cook IJ, Pavli P, Riley JW, Goulston KJ, Dent OF: Gastrointestinal investigation of iron deficiency anaemia. Br Med J 292:1380–1382, 1986

    Google Scholar 

  6. 6.

    Ward MC, Gundroo D, Bailey RJ, Metha TV, Vallon AG: Effect of investigation of the management of elderly patients with iron deficiency anaemia. Age Ageing 19:204–206, 1990

    PubMed  Google Scholar 

  7. 7.

    Tan CC, Guan R, Tay HH, Yap I, Math MV: The diagnostic yield of upper gastrointestinal endoscopy in the investigation of anaemia. Singapore Med J 32:157–159, 1991

    PubMed  Google Scholar 

  8. 8.

    Hershko C, Vitells A, Braverman DZ: Causes of iron-deficiency anemia in an adult inpatient population. Blut 49:347–352, 1984

    PubMed  Google Scholar 

  9. 9.

    Zuckerman G, Benitez J: A prospective study of bidirectional endoscopy (colonoscopy and EGD) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol 87:62–66, 1992

    PubMed  Google Scholar 

  10. 10.

    Dresner D, Jones M, Taylor WZ, Nemec R, Bowen M, Lawson JM: Role of endoscopy in the evaluation of iron deficiency anemia. Am J Gastroenterol 86:1131, 1991 (abstract)

    Google Scholar 

  11. 11.

    Tobin MV, Gilmore IT: Gastrointestinal investigation of iron deficiency anaemia. Br Med J 292:1738, 1986 (letter)

    Google Scholar 

  12. 12.

    Upadhyay R, Torley HI, McKinlay AW, Sturrock RD, Russell RI: Iron deficiency anaemia in patients with rheumatic disease receiving non-steroidal anti-inflammatory drugs: The role of upper gastrointestinal lesions. Ann Rheum Dis 49:359–362, 1990

    PubMed  Google Scholar 

  13. 13.

    Hsia PC, Al-Kawas FH: Yield of upper endoscopy in the evaluation of asymptomatic patients with hemoccult-positive stool after a negative colonoscopy. Am J Gastroenterol 87:1571–1574, 1992

    PubMed  Google Scholar 

  14. 14.

    Power GC, Smith RE: Prevalence of occult celiac disease in adults with iron deficiency anemia. Am J Gastroenterol 86:231, 1991 (abstract)

    Google Scholar 

  15. 15.

    Banerjee S, Clements D, Smith PM: Iron deficiency anaemia in the elderly. Age Ageing 20:152, 1991 (letter)

    PubMed  Google Scholar 

  16. 16.

    McIntyre AS, Long RG: Prospective survey of investigations in outpatients with iron deficiency anaemia. Gut 34:1102–1107, 1993

    PubMed  Google Scholar 

  17. 17.

    Rockey DC, Cello JP: Evaluation of the gastrointestinal tract in patients with iron deficiency anemia. N Engl J Med 329:1691–1695, 1993

    PubMed  Google Scholar 

  18. 18.

    Cook JD, Skikne BS: Iron deficiency: definition and diagnosis. J Intern Med 226:349–355, 1989

    PubMed  Google Scholar 

  19. 19.

    Finch CA, Huebers H: Perspectives in iron metabolism. N Engl J Med 306:1520–1528, 1982

    PubMed  Google Scholar 

  20. 20.

    Unger SW, Saranto JR, Furlong RJ, Scott JS: Single session panendoscopy. Am Surg 56:144–147, 1990

    PubMed  Google Scholar 

  21. 21.

    Triadafilopoulos G, Aslan A: Same-day upper and lower inpatient endoscopy: A trend for the future. Am J Gastroenterol 86:952–955, 1991

    PubMed  Google Scholar 

  22. 22.

    Hetzel DJ, Bonnin M: Long term management of hemorrhagic esophagitis with cimetidine and omeprazole. Aust NZ J Med 16:226–228, 1986

    Google Scholar 

  23. 23.

    Moskovitz M, Fadden R, Min T, Jansma D, Gavaler J: Large hiatal hernias, anemia, and linear gastric erosion: Studies of etiology and medical therapy. Am J Gastroenterol 87:622–626, 1992

    PubMed  Google Scholar 

  24. 24.

    Ahlquist DA, Klee GG, McGill DB, Ellefson RD: Colorectal cancer detection in the practice setting. Arch Intern Med 150:1041–1045, 1990

    PubMed  Google Scholar 

  25. 25.

    Foutch PG, Manne RK, Sanowski RA, Gaines JA: Risk factors for blood loss from adenomatous polyps of the large bowel: A colonoscopic evaluation with histopathological correlation. J Clin Gastroenterol 10:50–56, 1988

    PubMed  Google Scholar 

  26. 26.

    Hemingway AP: Angiodysplasia as a cause of iron deficiency anaemia. Blood Rev 3:147–151, 1989

    PubMed  Google Scholar 

  27. 27.

    Danesh BJZ, Spiliadis C, Williams CB, Zambartas CM: Angiodysplasia—an uncommon cause of colonic bleeding: Colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia. Int J Colorect Dis 2:218–222, 1987

    Google Scholar 

  28. 28.

    Arendt T, Barten M, Lakner V, Arendt R: Diffuse gastric antral vascular ectasia: Cause of chronic gastrointestinal blood loss. Endoscopy 19:218–220, 1987

    PubMed  Google Scholar 

  29. 29.

    Gostout CJ, Viggiano TR, Ahlquist DA, Wang KK, Larson MV, Balm R: The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol 15:256–263, 1992

    PubMed  Google Scholar 

  30. 30.

    Steger AC, Galland RB, Hemingway A, Wood CB, Spencer J: Gastrointestinal haemorrhage from a second source in patients with colonic angiodysplasia. Br J Surg 74:726–727, 1987

    PubMed  Google Scholar 

  31. 31.

    Randall GM, Jensen DM, Machicado GA, Weisz N, Hirabayashi K, Reddy TJ, CURE Hemostasis Group: Randomized study of direct current versus bipolar electrocoagulation probe for treatment of chronically bleeding internal hemorrhoids. Gastrointest Endosc 36:207–208, 1990

    Google Scholar 

  32. 32.

    Beddall A: Anaemias. Practioner 234:713–715, 1990

    Google Scholar 

  33. 33.

    Bickers JN: Deficiency anemias in gastrointestinal disease. Med Times 95:914–920, 1967

    PubMed  Google Scholar 

  34. 34.

    Bat L, Pines A, Rabau M, Niv Y, Shemesh E: Colonoscopic findings in patients with hemorrhoids rectal bleeding and normal rectoscopy. Isr J Med Sci 21:139–141, 1985

    PubMed  Google Scholar 

  35. 35.

    Corazza GR, Frisoni M, Treggiari EA, Valentini RA, Filliponi C, Volta U, Gasbarrini G: Subclinical celiac sprue. Increasing occurrence and clues to its diagnosis. J Clin Gastroenterol 16:16–21, 1993

    PubMed  Google Scholar 

  36. 36.

    Allison JE, Feldman R, Tekawa IS: Hemoccult screening in detecting colorectal neoplasm: Sensitivity, specificity, and predictive value. Ann Intern Med 112:328–333, 1990

    PubMed  Google Scholar 

  37. 37.

    Collins AJ, Davies J, St J Dixon A: Contrasting presentation and findings between patients with rheumatic complaints taking nonsteroidal anti-inflammatory drugs and a general population referred for endoscopy. Br J Rheumol 25:50–53, 1986

    Google Scholar 

  38. 38.

    Lanas A, Sekar MC, Hirschowitz BI: Objective evidence of aspirin use in both ulcer and nonulcer upper and lower gastrointestinal bleeding. Gastroenterology 103:862–869, 1992

    PubMed  Google Scholar 

  39. 39.

    Sayer JM, Long RG: A perspective on iron deficiency anemia. Gut 34:1297–1299, 1993

    PubMed  Google Scholar 

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Correspondence to Col Shailesh C. Kadakia MD.

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The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

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Kepczyk, M.T., Kadakia, C.S.C. Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Digest Dis Sci 40, 1283–1289 (1995). https://doi.org/10.1007/BF02065539

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Key words

  • iron-deficiency anemia
  • gastrointestinal bleeding
  • celiac disease
  • gastrointestinal endoscopy
  • enteroclysis