Relationship of iron-deficiency anemia with esophagitis and hiatal hernia:Hospital findings from a prospective, population-based study

OBJECTIVE: Iron-deficiency anemia is sometimes attributed to esophagitis an d hiatal hernia; however, because these GI conditions are so common, such a n association could be coincidental. We examined prospectively whether esop hagitis and hiatal hernia increased the risk of iron-deficiency anemia in a national, population-based study. METHODS: The study population comprised 5069 adult participants in the firs t National Health and Nutrition Examination Survey, who were free of GI hem orrhage and anemia at baseline examination in 1971-1975 and who were hospit alized at some point during nearly 20 yr of follow-up. Rates of hospitaliza tion with iron-deficiency or unspecified anemia were compared between patie nts with a hospital diagnosis of esophagitis or hiatal hernia and those who had not yet had a diagnosis of these disorders. Adjusted rate ratios were calculated using time-dependent, multivariable, proportional hazards analys is. RESULTS: During follow-up, 59 patients were hospitalized with esophagitis a lone, 140 with hiatal hernia alone, and 70 with both diagnoses. A total of 102 participants were hospitalized with iron-deficiency anemia and 256 with unspecified anemia. Compared to those without a diagnosis of esophagitis o r hiatal hernia, patients with a diagnosis of hiatal hernia had higher rate s of subsequent hospitalization with iron-deficiency anemia. The hazard rat e ratio (HRR) for hiatal hernia was 2.9 (95% confidence interval, 1.5-5.5). A trend was found for esophagitis with a HRR of 2.2 (95% confidence interv al, 0.79-6.0). Results were similar with unspecified anemia as the outcome. CONCLUSIONS: Hiatal hernia should be considered as a possible cause of iron -deficiency anemia. The relationship of esophagitis with iron-deficiency an emia requires further study. (C) 2001 by Am. Coll. of Gastroenterology.