A comprehensive evaluation of the gastrointestinal tract in iron-deficiency anemia with predefined hemoglobin below 9 mg/dL: A prospective cohort study

作者：Bosch Xavier^*; Montori Elisabet; Guerra Garcia Mar; Costa Rodriguez Jaime; Quintanilla Mariano H; Tolosa Chapasian Paula E; Moreno Pedro; Guasch Neus; Lopez Soto Alfons

来源：Digestive and Liver Disease, 2017, 49(4): 417-426.

DOI：10.1016/j.dld.2016.12.013

• Diffuse angiodysplasias
• Gastrointestinal cancer
• Iron-deficiency anemia
• Occult blood loss
• Quick diagnosis units

Background: Anemia is defined as hemoglobin below the cutoff of normal in studies examining the gastrointestinal (GI) tract in iron-deficiency anemia (IDA). Although the risk of GI cancer (GIC) increases as hemoglobin decreases, guidelines do not usually recommend hemoglobin thresholds for IDA investigation.
Methods: To elucidate whether underlying GI disorders explain the different hemoglobin values and clinical outcomes observed initially in IDA patients referred for GI workup, we prospectively investigated the diagnostic yield of a thorough GI examination in consecutive IDA adults with predefined hemoglobin < 9 g/dL and no extraintestinal bleeding.
Results: 4552 patients were enrolled over 10 years. 96% of 4038 GI lesions were consistent with occult bleeding disorders and 4% with non-bleeding disorders. Predominant bleeding disorders included upper GI ulcerative/erosive lesions (51%), GIC (15%), and angiodysplasias (12%). Diffuse angiodysplasias (45% of angiodysplasias) and GIC showed the lowest hemoglobin values (6.3 [1.5] and 6.4 [1.3] g/dL, respectively). While the spread (diffuse vs. localized) and number (< 3 vs. >= 3) of angiodysplasias correlated with the degree of anemia, hemoglobin values were lower in GIC with vs. without ulcerated/friable lesions (6.0 [1.1] vs. 7.0 [1.2] g/dL, P < 0.001).
Conclusion: Not only GIC but also diffuse angiodysplasias caused the most severe anemia in IDA with predefined hemoglobin values <9 g/dL.

• 出版日期2017-4
• 单位河北医科大学