ROLE OF SMALL-BOWEL BIOPSY IN THE ENDOSCOPIC EVALUATION OF ADULTS WITH IRON-DEFICIENCY ANEMIA

Objectives: The recommended evaluation of adult patients presenting wi th iron deficiency anemia (IDA) includes the performance of colonoscop y and esophagogastroduodenoscopy. IDA is a common feature in patients with celiac disease and, in several, may be the only presenting sign. The performance of small bowel biopsy (SBB) for the evaluation of celi ac disease as the cause of IDA is not routinely recommended. The aim o f the present study was to determine the yield of SBB performed during routine endoscopy of adults with IDA. Methods: We prospectively studi ed 93 patients with LDA. Three control groups were included: 23 patien ts with steatorrhea, 37 patients with idiopathic diarrhea, and 9 patie nts in whom SBB was performed for miscellaneous indications. Results: Eleven patients with IDA and two patients with steatorrhea had SBB fin dings compatible with celiac disease. None of the patients from the ot her two groups had similar findings. Two patients with IDA, who were l ater diagnosed to suffer from celiac disease, presented: one with occu lt blood in the stool and the other with rectal bleeding. Subgroup ana lysis of patients with IDA revealed that patients with celiac disease were younger, had significantly more episodes of diarrhea, lower mean hemoglobin level, and longer duration of anemia than those without cel iac disease. Other mucosal abnormalities were found in a substantial n umber of patients with celiac disease: esophagitis, gastritis, duodeni tis, hemorrhoids, and colitis. Conclusions: A substantial number of ad ult Israeli patients who present with IDA are found, on SBB, to have m ucosal abnormalities compatible with the diagnosis of celiac disease. The presence of esophagitis, gastritis, or duodenitis on esophagogastr oduodenoscopy, or other abnormalities on colonoscopy, do not exclude t he coexistence of celiac disease. Celiac disease should be included an d routinely looked for in the differential diagnosis of adult patients with IDA.