Search

PURPOSE: Iron deficiency anemia is often attributed to menstrual blood loss in premenopausal women. The aims of this study were to determine the diagnostic yield of endoscopy and to evaluate the clinical outcome in these women. METHODS: Charts, endoscopy records, and pathology reports were reviewed in consecutive premenopausal women with documented iron deficiency anemia who were referred for diagnostic endoscopy. Follow-up was obtained by telephone contact and review of medical records. RESULTS: Endoscopy revealed a clinically important lesion in 23 (12%) of 186 patients. An upper gastrointestinal source was identified in 12 patients, most commonly due to gastric cancer (3%) or peptic ulcer disease (3%). A colonic lesion was detected in 11 patients, with colon cancer in six (3%). No patient had a lesion identified in both the upper and lower gastrointestinal tract. Small bowel biopsies and radiography were normal in all patients in whom they were obtained. Independent predictors for having a gastrointestinal lesion identified by endoscopy include a positive fecal occult blood test, a hemoglobin of [is less than] 10 g/dL, and abdominal symptoms. Long-term follow-up data suggested a favorable prognosis, and iron deficiency anemia resolved with appropriate therapy in nearly all patients. CONCLUSIONS: Endoscopy yields important findings in premenopausal women with iron deficiency anemia, which should not be attributed solely to menstrual blood loss. Am J Med. 1998;105:281-286. [C] 1998 by Excerpta Medica, Inc.

BACKGROUND: Although endoscopic evaluation of the gastrointestinal tract is commonly performed to evaluate iron deficiency, little data is available regarding the underlying causes, yield of evaluation, and long-term outcome for those in whom gastrointestinal and systemic symptoms and signs are absent. METHODS: In- or out-patients seen by the gastroenterology consultative service at a large inner-city hospital over a 56-month period were considered eligible for the study when iron deficiency (serum ferritin [is less than] 50 ng/mL) was documented. Exclusion criteria included: any gastrointestinal or systemic symptoms/signs, radiographic or endoscopic examinations of the gastrointestinal tract within 3 and 5 years, respectively, or obvious source of blood loss. Patients underwent colonoscopy and if no lesions other than carcinoma were found, upper endoscopy was then performed with a pediatric colonoscope. RESULTS: Fifty-two patients were evaluated (mean age, 66 [+ or -] 13 years; range, 20 to 89 years; 32 men/20 women). At the time of evaluation, the mean ([+ or -]SD) hematocrit was 25% [+ or -] 7% (range, 14% to 42%). Overall, 23 patients (44%; 95% Cl 30% to 59%) had an identifiable gastrointestinal lesion considered the cause of iron deficiency, including: colonic carcinoma, 11 (21%); colonic and/or esophagogastric/duodenal vascular ectasias, 9 (17%); and gastric carcinoma, colonic polyposis, and colonic ulcers in 1 patient each. Long-term follow-up (median 24 months, range 2 to 63 months) identified only 1 patient with a cause found (colonic carcinoma), and in this patient, complete colonoscopy was not technically possible at the time of initial evaluation. There were no clinical or laboratory features that distinguished patients with an etiology for iron deficiency to the idiopathic group. CONCLUSIONS: Approximately half of patients with iron deficiency in whom gastrointestinal or systemic signs or symptoms are absent have an underlying gastrointestinal lesion. Nevertheless, despite a thorough endoscopic evaluation, some patients will have no etiology found; the prognosis for these patient is excellent.