Clinical Articles
Copyright ©The Author(s) 1996. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 25, 1996; 2(2): 95-98
Published online Jun 25, 1996. doi: 10.3748/wjg.v2.i2.95
Endoscopic evaluation of gastrointestinal tract lesions in patients with iron-deficiency anemia
Chang-Tai Xu, Rui-Ling Wang, Bo-Rong Pan
Chang-Tai Xu, Physician-in-Charge, having 65 papers and 2 books published, Director of the Department of Gastroenterology & Haematology, AirForce 473 Hospital, Lanzhou 730070, Gansu Province, China
Rui-Ling Wang, Air Force 473 Hospital, Lanzhou 730070, Gansu Province, China
Bo-Rong Pan, Professor of Internal Medicine, Fourth Military Medical University, Xi′an 710033, Shaanxi Province, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Chang-Tai Xu, Physician-in-Charge, Director of the Department of Gastroenterology & Haematology, AirForce 473 Hospital, 216 Anningdonglu, Lanzhou 730070, Gansu Province, China
Telephone: +86-931-7662362
Received: December 9, 1995
Revised: May 25, 1996
Accepted: June 10, 1996
Published online: June 25, 1996

AIM: To prospectively evaluate the relation of gastrointestinal lesions and iron-deficiency anemia (IDA) caused by gastrointestinal tract bleeding.

METHODS: Sixty-one patients with IDA caused by gastrointestinal tract bleeding were included in our study. Lesions were detected by esophagogastroduodenoscopy (EGD) and/or colonoscopy. Histories of upper gastrointestinal tract symptoms, including pyrosis, dysphagia, upper abdominal pain, dyspepsia, nausea and vomiting, and lower gastrointestinal tract symptoms such as changes in bowel habits, constipation, diarrhea and lower abdominal pain, were obtained from each patient. History of NSAID drugs intake was also obtained. Each patient underwent complete physical examination and fecal occult blood test (FOBT) of three spontaneously passed stools or of stool samples obtained by digital rectal examination. All the patients completed testing for complete blood count, total iron-binding capacity, and serum ferritin level. Some patients underwent bone marrow aspiration to examine the iron stores.

RESULTS: The 61 patients included 35 men and 26 women, with mean age of 53.6 years (range of 18-67 years). The mean hemoglobin level was 82-19 g/L and the mean ferritin level was 8.9 ± 4.8 μmol/L. In the 10 patients diagnosed with concomitant inflammatory conditions, the ferritin levels were lower, ranging between 1.8 μmol/L and 4.2 μmol/L, and the patients showed an elevated white blood cell count. The mean transferritin saturation was 6.8% ± 4.2%. Bone marrow aspiration was performed on 5 patients to confirm IDA. The upper endoscopic findings of 43 patients with IDA included gastric erosions (n = 10), esophagitis (n = 8), gastric cancer (n = 6), gastric ulcer (n = 8), duodenal ulcer (n = 9), gastric polyps (n = 1) and esophageal cancer (n = 1). Colonoscopic findings of 18 patients with IDA included colon cancer (n = 2), colon polyp (n = 6), ulcerative colitis (n = 9), and Crohn’s colitis (n = 1). Five of the total 61 (8.2%) patients had lesions in both the upper and lower gastrointestinal tract that met our criteria for potentially causing IDA.

CONCLUSION: Combined application of EGD and colonoscopy is able to identify potential bleeding sources in most patients with IDA.

Keywords: Anemia, iron-deficiency, Gastrointestinal hemorrhage, Endoscopy