Gastrointestinal endoscopic findings in men with unexplained anemia and low normal ferritin values

Abstract

Background: Most practice guidelines recommend endoscopic evaluation of the gastrointestinal (GI) tract in men and postmenopausal women with anemia and a serum ferritin less than 20-40 ng/ml. The diagnostic yield of endoscopy in patients with anemia, no GI symptoms or signs, and low normal ferritin is not known. Objective: The aim of this study was to investigate the yield of upper and lower GI endoscopic evaluations in anemic patients with ferritin levels between 40 and 100 ng/ml. Design: A retrospective review of patients' charts was conducted. Subjects and methods: Patients at the Veterans Affairs Connecticut Healthcare System who underwent GI endoscopic evaluation for the sole indication of anemia and ferritin in the low normal range (40-100 ng/ml) were included in this study. Measurements: Incidence of pathology of the upper and lower GI tract was determined. Results: We identified 54 male patients who had a ferritin level of 40-100 ng/ml and no GI symptoms or known GI bleeding. Upper GI findings (malignancy, peptic ulcers, Helicobacter pylori gastritis, arteriovenous malformations) were found in 14/47 cases (30%). Lower gastrointestinal findings, including large tubular adenomas and arteriovenous malformation, were identified in 3/53 cases (6.7%). Conclusion: Our study supports GI endoscopy in anemic patients with ferritin between 40 and 100 ng/ml, even in the absence of GI symptoms or documented bleeding. Am. J. Hematol. 81:324-327, 2006. V V C 2006 Wiley-Liss, Inc.

A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis

“…20 The diagnostic rate of upper and lower endoscopy plus ileoscopy in our patient population (76.2%) is in agreement with previously published data that have shown a diagnostic rate ranging from 56.2% to 85.5%. [21][22][23][24] The variability of these results is possibly because of inclusion criteria, age, and significant findings considered, which were largely heterogeneous among studies. The relatively high diagnostic rate of endoscopy could be because of the nature of the setting of our unit, which is an open-access endoscopy unit within a university-based tertiary-care referral center.…”

Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms

“…The available literature, in heterogeneous groups including old age patients and postmenopausal women with IDA, has shown GI lesions in 40 – 70% [ 4 - 6 ]. Studies have shown that increasing age, male gender, ferritin level, prior NSAIDs use, positive fecal occult blood test were factors predictors of endoscopic lesions in patients with IDA with and without GI symptoms [ 7 - 11 ]. Studies have concluded that prevalence of endoscopic lesions in patients with IDA without GI symptoms is between 48 – 71%, [ 9 - 12 ] however there is a sparse data related to factors predicting GI lesions in this group.…”

Helicobacter pylori Seroprevalence in Symptomatic Veterans: A Study of 7310 Patients Over 11 Years

“…Although several early pivotal studies on H. pylori , its associated conditions, and their treatment have been performed in Veterans Affairs hospitals [10–13], no recent studies have specifically addressed the dynamics of H. pylori infection among US veterans. This study was designed to evaluate the changes in the prevalence of anti‐ H. pylori serum antibodies in primary care patients at a large Veterans Affairs hospital serving more than half a million veterans in urban, suburban, and rural areas in northeastern Texas.…”