Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia

Ioannou, George N.; Spector, J. Gershon; Scott, Kevin; Rockey, Don C.

doi:10.1016/s0002-9343(02)01226-3

Cited by 54 publications

(19 citation statements)

References 20 publications

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“…GI guidelines 16,17 have either been established before the clinical application of VCE, which allows an accurate examination of the whole small bowel, or, when IDA has been included as an indication for VCE, 18 it is not systematically considered in clinical practice. In fact, in a recent study 19 on 145 patients who had undergone capsule endoscopy, only 4 patients (2.8%) were referred for IDA.…”

Section: Discussionmentioning

confidence: 99%

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

Milano

Balatsinou

Filippone

et al. 2011

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

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

Milano

Balatsinou

Filippone

et al. 2011

Gastrointestinal Endoscopy

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“…This is particularly important, because a large proportion of patients with IDA does not undergo endoscopy or are incompletely evaluated, despite specific guidelines 16-17. These procedures are not cost-effective for each IDA patients.…”

Section: Discussionmentioning

confidence: 99%

Identification of clinical and simple laboratory variables predicting responsible gastrointestinal lesions in patients with iron deficiency anemia

Şerefhanoğlu¹,

Büyükaşık²,

Emmüngil³

et al. 2011

Int. J. Med. Sci.

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Iron deficiency anemia (IDA) is a frequent disorder. Also, it may be a sign of underlying serious diseases. Iron deficiency points to an occult or frank bleeding lesion when occurred in men or postmenopausal women. In this study, we aimed to evaluate the diagnostic yield of endoscopy in patients with IDA and to define predictive factors of gastrointestinal (GI) lesions causing IDA. Ninety-one patients (77 women, 14 men; mean age: 43 years) who were decided to have esophago-duodenoscopy and/or colonoscopy for iron deficiency anemia were interviewed and responded to a questionnaire that included clinical and biochemical variables. The endoscopic findings were recorded as GI lesions causing IDA or not causing IDA. Endoscopy revealed a source of IDA in 18.6 % of cases. The risk factors for finding GI lesions causing IDA were as follows: male gender (p= 0.004), advanced age (> 50 years) (p= 0.010), weight loss (over 20% of total body weight lost in last 6 month) (p= 0.020), chronic diarrhea (p= 0.006), change of bowel habits (p= 0.043), epigastric tenderness (p= 0.037), raised carcinoembryonic antigen (CEA) level (normal range: 0-7 ng/mL) (p= 0.039), < 10 gr/dl hemoglobin (Hb) level (p=0.054). None of these risk factors had been present in 21 (23%) women younger than 51 years. In this group, no patient had any GI lesion likely to cause IDA (negative predictive value= 100%). In multivariate analysis, advanced age (p=0.017), male gender (p< 0.01) and weight lost (p=0.012) found that associated with GI lesions in all patients. It may be an appropriate clinical approach to consider these risk factors when deciding for gastrointestinal endoscopic evaluation in iron deficiency anemia.

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“…Patients with OGIB are frequently referred to endoscopists for evaluation and undergo procedures in order to locate the source of bleeding. After investigating the upper and lower parts of the gastrointestinal tract, the source of bleeding remains unidentified in about 10% of patients [1,2,3,4,5, 9]. OGIB may be responsible for chronic anemia, positive fecal occult blood, or recurrent hemorrhagic shock, and for the need of repeated blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…Although these patients are often referred to endoscopists for the purpose of identifying the source of bleeding, there are relatively few published reports on the evaluation of the small bowel of patients with OGIB [1, 2]. OGIB patients are usually evaluated by endoscopic esophagogastroduodenoscopy (EGD) and colonoscopy and/or radiography (air-contrast barium enema and upper gastrointestinal series) [1,2,3,4,5]. Radiographic studies are generally effective in detecting masses and large ulcerating lesions [6, 7], but their sensitivity for vascular ectasias and more subtle mucosal lesions, such as gastritis, esophagitis, and colitis, is less than that of endoscopic procedures.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Yield of Capsule Endoscopy in Obscure Gastrointestinal Bleeding

Fireman

Friedman²

2004

Digestion

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Objectives:Chronic occult blood loss from the gastrointestinal tract is a recognized major cause of iron-deficiency anemia. After conventional investigation of the upper and lower parts of the gastrointestinal tract, the source of bleeding remains unidentified in ~10% of these patients. We evaluated the diagnostic yield of capsule endoscopy from patients enrolled in clinical studies due to persistent or recurrent iron-deficiency anemia. Methods: In this large cohort study, patients with obscure gastrointestinal bleeding were identified in a company-sponsored clinical study (Given Imaging, Ltd.) database which contains data from >50 clinical studies. Information on suitable patients was derived from 31 of them. Each subject swallowed an M2A^® Given Capsule containing a miniature video camera, batteries, a transmitter and an antenna. Recording time was ~8 h. The capsule was excreted naturally in the patient’s bowel movement, and the data it transmitted were retrieved and interpreted the next day. Results: 293 patients were studied (135 males, 46.1%, mean age 59.4 ± 16.8 years) whose mean number of bleeding episodes was 4.3 ± 5.5 and mean hemoglobin level was 9.8 ± 2.4 g/dl. The average number of diagnostic procedures per patient prior to the capsule endoscopy study was 5.59. Capsule endoscopy detected definitive findings in 213/293 patients (72%) and findings missed by other diagnostic procedures in 22/293 patients (8%). Neither capsule endoscopy nor the other diagnostic procedures yielded diagnoses in 58/293 patients (20%). Conclusions: Capsule endoscopy has a high diagnostic yield in evaluating patients with obscure gastrointestinal bleeding.

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Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia

Cited by 54 publications

References 20 publications

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

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

Identification of clinical and simple laboratory variables predicting responsible gastrointestinal lesions in patients with iron deficiency anemia

Diagnostic Yield of Capsule Endoscopy in Obscure Gastrointestinal Bleeding

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