SERIOUS GASTROINTESTINAL PATHOLOGY FOUND IN PATIENTS WITH SERUM FERRITIN VALUES LESS-THAN-OR-EQUAL-TO-50 NG ML/

Objective: Our aim was to evaluate the gastrointestinal tract in patie nts with serum ferritin values less than or equal to 50 ng/ml for the presence of serious gastrointestinal pathology, including neoplasia an d acid peptic disease. Methods: In this prospective observational stud y, patients with serum ferritin values less than or equal to 50 ng/ml who did not have an obvious cause of iron deficiency underwent colonos copy and/or esophagogastroduodenoscopy. Results: Between October 1, 19 94, and February 29, 1996, 725 of 3015 patients who had serum ferritin determinations were found to have values less than or equal to 50 ng/ ml, To date, 143 patients have been fully evaluated and 77 were found to have serious gastrointestinal pathology including acid peptic disea se (N = 46), cancer (N = 15), and large adenomas (N = 6), Colon cancer was discovered in five asymptomatic patients. The prevalences of seri ous gastrointestinal pathology did not differ between patients with se rum ferritin values less than or equal to 20 ng/ml and those with valu es between 21-50 ng/ml (63% vs 48%, p = 0.07), However, multivariate a nalysis showed that the presence of upper or lower gastrointestinal sy mptoms and serum ferritin value less than or equal to 20 ng/ml is pred ictive of finding serious pathology (p = 0.0002 for the whole model), with odds ratios of 3.8 (95% confidence interval of 1.84-7.70) for pre sence of gastrointestinal symptoms and 2.2 (95% confidence interval of 1.09-4.57) for serum ferritin value less than or equal to 20 ng/ml, C onclusions: Endoscopic examination is warranted in patients with serum ferritin values less than or equal to 50 ng/ml to detect serious gast rointestinal pathology, present in 54% of such patients. (C) 1998 by A m. Coll. of Gastroenterology.