Original ArticleEvaluation of iron deficiency anaemia for gastrointestinal causes in patients without GI symptoms in high prevalent GI malignancy zones
Introduction
The most common cause of hypochromic microcytic anaemia worldwide is iron deficiency anaemia (IDA) [1]. In males and postmenopausal females, iron deficiency occurs due to chronic blood loss from the gastrointestinal (GI) tract [2], [3]. Iron deficiency is identified by abnormal iron levels in addition to low haemoglobin (Hb) levels [4]. In the developed world, iron deficiency occurs in 2–5% of adult males and postmenopausal females [5]. It is a leading cause of patient referral to gastroenterologists [6], [2]. Asymptomatic colonic and gastric carcinoma may present with IDA; thus, identifying these conditions is crucial in patients with IDA. Management of IDA is often suboptimal, as most patients are either incompletely investigated or not investigated at all [7]. The causes of IDA are related to either low intake, malabsorption of iron, or blood loss. After confirmation with laboratory tests, GI evaluation is usually indicated to exclude GI malignancies. There is little consensus about the level of anaemia that requires investigation. The National Institute of Health and Clinical Excellence referral guidelines for suspected lower gastrointestinal (LGI) malignancy recommend that only patients with Hb concentration <11 g/dl in males and <10 g/dl in non-menstruating females be referred [8]. With these cutoff values, patients with colorectal cancer, especially men, are likely to be missed [9]. Thus, it is recommended that any level of anaemia be investigated in the presence of iron deficiency. Furthermore, men with Hb concentration <12 g/dl and postmenopausal females with Hb concentration <10 g/dl should be investigated more urgently, as lower levels of Hb indicate a more serious disease [9]. We aimed to examine adult patients with iron deficiency but no GI symptoms so as to determine the most plausible cause of IDA.
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Patients and methods
The study was conducted in the Division of Gastroenterology, Department of Medicine, Government Medical College, Srinagar, Kashmir. This was a cross-sectional, comparative, observational study conducted over a period of 2 years starting from January 2010. With the approval of the institutional ethics committee, this study was carried out with the aim of determining the “most common lesion likely to contribute to iron deficiency anaemia.” This study included 100 patients and 250 control subjects
Results
The majority of the participants (patients as well as controls) were males (65.60%). Sixty-six percent of patients and 66.4% of controls were from rural areas. The majority of patients were between the ages of 35 and 65 years (65% and only 13% were below the age of 35) (Table 1). Almost all patients presented with symptoms of anaemia, with three patients suffering congestive cardiac failure (CCF). The majority of controls who underwent UGI endoscopy presented with dyspepsia (88%), and their
Discussion
This cross-sectional, comparative, observational study was conducted at the Department of Gastroenterology, Government Medical College, Srinagar, J&K, India. Hundred patients with IDA were admitted and evaluated on an inpatient department (IPD) basis. A total of 250 equally matched controls were enrolled on an outpatient department (OPD) basis, 100 for UGI endoscopy and 150 for LGI endoscopy after obtaining clearance from the institutional ethics committee. All of the patients and controls were
Conflicts of interest
The authors declared that there was no conflict of interest.
References (42)
- et al.
Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia
Blood
(2004) - et al.
Gastrointestinal causes of refractory iron deficiency anemia in patient without gastrointestinal symptoms
Am J Med
(2001) - et al.
Upper and lower gastrointestinal evaluation of elderly patients who are iron deficient
Am J Med
(1999) - et al.
Iron status and colorectal cancer in symptomatic elderly patients
Am J Med
(2008) - et al.
Role of small bowel investigation in iron deficiency anemia after negative endoscopic/histologic evaluation of the upper and lower gastrointestinal tract
Dig Liver Dis
(2003 Nov) - et al.
Enteroscopy for the initial evaluation of iron deficiency
Gastrointest Endosc
(1998 Feb) - et al.
The role of video capsule endoscopy in the evaluation of iron deficiency anemia
Dig Liver Dis
(2004 Feb) - et al.
Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia
Am J Med
(1998 Oct) - et al.
Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs
Am J Med
(1997 Nov) - et al.
Approach to the diagnosis and treatment of chronic anemia secondary to gastrointestinal diseases
Gastroenterol Hepatol
(2014 Dec)