A PROSPECTIVE-STUDY OF THE GASTROENTEROLOGICAL CAUSES OF IRON-DEFICIENCY ANEMIA IN A GENERAL-HOSPITAL

Background: Current practice is to investigate routinely both upper an d lower gastrointestinal tracts in patients with unexplained iron defi ciency anaemia. Aims: To determine the efficacy of this approach and w hether the use of more stringent biochemical criteria for iron deficie ncy, symptoms, or a positive immunochemical faecal human haemoglobin ( FHH) influenced the findings of the investigations and could help targ et investigations more efficiently. Methods: Eighty patients were stud ied prospectively, 51 who had 'definite' iron deficiency anaemia (low ferritin and transferrin saturation) and 29 with 'probable' iron defic iency anaemia (either low ferritin or transferrin saturation). Patient s underwent a standardised symptom assessment and testing for FHH, upp er endoscopy with small bowel biopsy and colonoscopy, and a small bowe l series if upper endoscopy and colonoscopy were negative. Results: Le sions potentially causative for iron deficiency anaemia were found in 54/80 (60%) of patients. Five patients (7%) had lesions in both upper and lower tracts. Small bowel biopsy was abnormal in one of 80 patient s and small bowel series one of 25 patients. Significant lesions in ei ther the upper or lower gastrointestinal tract were found in 14/20 pat ients with positive FHH and 25/47 with negative FHH. Symptoms, use of non-steroidal anti-inflammatory drugs and classification of patients i nto 'definite' and 'probable' iron deficiency did not influence yield of investigations or site of lesions found. Conclusions: Gastrointesti nal lesions are common in patients with unexplained iron deficiency an aemia. Neither symptoms nor presence of FHH predict the presence or si te of detectable lesions and neither testing for FHH nor more stringen t biochemical criteria for iron deficiency alters clinical decision ma king. The findings support the routine performance of both upper endos copy and colonoscopy in the investigation of patients with unexplained iron deficiency anaemia, however routine investigation of the small b owel is of questionable value.