EVALUATION OF THE GASTROINTESTINAL-TRACT IN PREMENOPAUSAL WOMEN WITH IRON-DEFICIENCY ANEMIA

PURPOSE: Iron deficiency anemia is often attributed to menstrual blood loss in premenopausal women. The aims of this study were to determine the diagnostic yield of endoscopy and to evaluate the clinical outcom e in these women. METHODS: Charts, endoscopy records, and pathology re ports were reviewed in consecutive premenopausal women with documented iron deficiency anemia who were referred for diagnostic endoscopy. Fo llow-up was obtained by telephone contact and review of medical record s. RESULTS: Endoscopy revealed a clinically important lesion in 23 (12 %) of 186 patients. An upper gastrointestinal source was identified in 12 patients, most commonly due to gastric cancer (3%) or peptic ulcer disease (3%). A colonic lesion was detected in 11 patients, with colo n cancer in six (3%). No patient had a lesion identified in both the u pper and lower gastrointestinal tract. Small bowel biopsies and radiog raphy were normal in all patients in whom they were obtained. Independ ent predictors for having a gastrointestinal lesion identified by endo scopy include a positive fecal occult blood test, a hemoglobin of <10 g/dL, and abdominal symptoms. Long-term follow-up data suggested a fav orable prognosis, and iron deficiency anemia resolved with appropriate therapy in nearly all patients. CONCLUSIONS: Endoscopy yields importa nt findings in premenopausal women with iron deficiency anemia, which should not be attributed solely to menstrual blood loss. (C) 1998 by E xcerpta Medica, Inc.