Z. Ackerman et al., ROLE OF SMALL-BOWEL BIOPSY IN THE ENDOSCOPIC EVALUATION OF ADULTS WITH IRON-DEFICIENCY ANEMIA, The American journal of gastroenterology, 91(10), 1996, pp. 2099-2102
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.