Prevalence of Gastrointestinal Findings Responsible for Anemia in Different Groups of Anemic Patients: Retrospective Study from a Large Tertiary Hospital
Thepwiwatjit S, MD1, Aussavavirojekul P, MD1, Manomaiwong N, MD1, Sriprayoon T, MD1, Pongprasobchai S, MD2
Affiliation : 1 Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Gastrointestinal (GI) evaluation with bidirectional endoscopy is recommended in patients with iron deficiency anemia
(IDA). In practice, however, 2 other settings are anemic patients with some clinical clues and patients who have only anemia.
Diagnostic yield of bidirectional endoscopy in the latter 2 settings are unknown.
Materials and Methods: All patients who underwent bidirectional endoscopy for anemia during 2011 to 2016 were reviewed.
Patients were divided into 3 groups (group A, definite IDA; group B, anemia with some clues; group C, anemia without definite proof
of IDA or any clinical clue). Prevalence of significant lesions and details were analyzed.
Results : Three hundred twenty-five patients were enrolled (43 in group A, 95 in group B and 187 in group C). Significant GI lesions
were found in 62.8%, 32.6% and 24.1% and cancers were found in 16.3%, 10.5% and 2.7%, respectively. From EGD, 39.5% of
patients in group A, 18.9% of group B, and 15.5% of group C had significant GI lesions and the most common lesion was erosive
gastroduodenitis. From colonoscopy, 14% of group A, 7.4% of group B, and 7.0% of group C had significant GI lesions and the most
common lesion was colonic carcinoma. Dual lesions were found in 9.3%, 6.3%, and 1.6% of group A, B, and C, respectively. Multivariate
analyses showed no predictor for significant GI lesions in group B, but reveled hemoglobin <9 g/dL to be significant predictor in
group C (odds ratio 6.07, 95% confidence interval 1.1 to 33.9, p = 0.04).
Conclusion : Significant GI lesions detected by bidirectional endoscopy in patients with definite IDA, anemia with some clinical clues
of GI blood loss, and unconfirmed IDA without any clinical clue of GI blood loss were 63%, 33% and 24%, respectively. Erosive
gastroduodenitis and colonic carcinoma were the most common significant upper and lower GI lesions, respectively. Patients with
Hb <9 g/dL predicted significant lesions in anemia patients without IDA confirmation.
Keywords : Anemia, Endoscopy, Evaluation, Gastrointestinal
