Long-term follow-up of patients with iron deficiency anemia after a close endoscopic examination of the upper and lower gastrointestinal tract

Background: In patients with Iron Deficiency Anemia (IDA) occult gastrointe stinal bleeding is generally investigated by bidirectional endoscopy. The a im of our study was to examine the long-term follow-up of patients with IDA where the sources of bleeding couldnt be detected despite close endoscopic and radiologic examnination of the GI tract. Methods: Based on the endoscopic data base we examined consecutive patients who were referred for gastrointestinal endoscopy due to IDA with a negativ e endoscopic (upper GI endoscopy and colonoscopy) evaluation. Further diagn ostic work up (repeated endoscopy of the upper and lower GI tract by an exp erienced investigator, small bowel enteroclysis, push enteroscopy, proctosc opy, intraoperative enteroscopy, angiography, scintigraphic examinations) w as recorded. The eligible patients were divided into 2 groups: Group 1 (no identification of the source of bleeding in the GI tract); group 2 (source of gastrointestinal blood loss was found). Long-term follow-up was performe d by telephone interview with patients and/or with their general practition er. Results: 79 patients (mean age 58.8 years [17-83, 44] female) with IDA met the inclusion criteria. In 42 patients (53%) the endoscopic and radiographi c evaluation was unable to find the source of gastrointestinal blood loss. 29 of these patients (69%) showed a resolved anemia after a mean follow-up of 48 months (18 months - 5 years). 10 patients had a mild anemia, 3 requir ed blood transfusions. In group one Helicobacter pylori infection was signi ficantly more prevalent in comparison with group 2 (57% vs. 38%, p = 0.032) . Conclusion: Based on our data, the prognosis of IDA with negative endoscopy is favorable. The pathogenic role of Helicobacter pylori infection should be evaluated in further studies.