Summery:
Background: Anaemia is common among general
population in developing Asian countries. Iron deficiency
anaemia (IDA) is the commonest type of anaemia. It is usually
due to chronic gastrointestinal blood loss. The standard of
care for these patients with IDA includes evaluation of the
Gastrointestinal (GI) tract for bleeding lesions. Iron
deficiency anemia is considered as an alarm sign for the
presence of possible GI malignancies, and inadequate
evaluation of patients with IDA may delay the diagnosis of
GI tumors especially colorectal cancer.
Objective: To identify the gastrointestinal lesions
endoscopically in patients with iron deficiency anaemia. To
determine the usefulness of endoscopic procedures (both
upper and lower GI) in diagnosis of underlying cause of
iron deficiency.
Method: This cross-sectional study was conducted to evaluate
Iron deficiency anaemia in patients with or without GI
symptoms during the period of July 2010 to December 2010
in the department of Gastroenterology, BIRDEM General
Hospital. Sixty eight adult eligible patients with iron
deficiency anaemia were taken as per inclusion criteria. All
study subjects were underwent endoscopy and colonoscopic
procedure after adequate preparation along with
examination of their stool. Data were collected through faceto-
face interview, observation and document review. Data
were recorded and analyzed.
Results: Majority of patients were 55 to 64 years age group
(33.8%). Mean age ± SD of this study subject was 54.00
±11.792 with maximum and minimum age 86 and 27 years
respectively. More than half of the patients were female
(51.5%) and rests were male 33 (48.5%). Among the study
subjects, 70.58% patients had GI symptoms, 29.42% had
non-GI symptoms. On stool examination, 17.64% patients
had ova/cyst of helminthes; 82.36% were normal. Stool OBT
revealed 11.8% positive and 88.2% negative. On upper GI
endoscopy 32.4% had normal findings, 67.6% had some
lesions. Majority of these lesions were ulcers and erosions
(30.9%), malignancy (ca stomach) was 4.41%; others (which
includes congestive gastropathy, reflux oesophagitis, vascular
ectasias and helminthiasis) were 32.4%. On colonoscopy,
30.88% patients had normal colon; 69.12% had lesions.
Among the lesions, most common lesion was hemorrhoids
(36.76%); ca colon was 5.88% and others (includes ulcers,
polyps, vascular ectasias and helminthes) were 26.47%.
Patients with normal upper GI endoscopy- 50% had GI
symptoms and 50% had non-GI symptoms whereas patients
having lesions on upper GI endoscopy 80.4% had GI
symptoms and 19.6% had non-GI symptoms. This difference
was statistically significant (p<0.05).
Patients with normal colonoscopy- 42.9% had GI symptoms
and 57.1% had non-GI symptoms. On the other hand,
patients having lesions on colonoscopy 70.6% had GI
symptoms and 29.4% had non-GI symptoms. This was also
statistically significant.
Conclusion: Majority of the study population had lesions
on endoscopy (both upper GI endoscopy and colonoscopy)
including malignant lesions. Study showed that lesions are
more common in patients with GI symptoms than those
without GI symptoms (non-GI symptoms). Therefore, Routine
endoscopic (both upper and lower GI) procedures is valuable
in evaluating patients with iron deficiency anaemia- for
diagnostic as well as therapeutic purposes. Effective treatment
of patients with IDA is predicated on the identification of a
specific lesion.
(J Banagladesh Coll Phys Surg 2015; 33: 126-132)