Abstract
Background
Iron deficiency anemia in the absence of overt bleeding can result from chronic occult blood loss from the gastrointestinal tract. When esophagogastroduodenoscopy (EGD) and colonoscopy fail to demonstrate clinically significant lesions (CSLs), practitioners often consider small bowel investigations, such as CT enterography and video capsule endoscopy. Although most society guidelines recommend further investigations to evaluate the small bowel, few studies have evaluated the utility of small bowel radiographic imaging in this setting.Methods
This is a retrospective cross-sectional study investigating the rates and types of CSLs identified during EGD, colonoscopy and small bowel imaging among individuals over age 50 who were referred for new-onset iron deficiency anemia without overt bleeding. Data was collected on 334 consecutive patients who underwent colonoscopy with or without EGD to evaluate new-onset iron deficiency anemia at The Ottawa Hospital from January 1, 2010 to March 30, 2012. We evaluated the frequency of CSLs among all patients and those who further underwent small bowel radiographic imaging.Results
Of the 332 individuals who underwent colonoscopy, 42 (12.7%) were found to have a CSL, with 37 of these being malignancy or high-grade adenomas. Of the 258 individuals who also underwent EGD, 49 (19.0%) had CSLs, including 11 vascular ectasias, 15 peptic ulcer disease, 8 celiac disease, 8 severe erosive esophagitis, and 9 esophageal varices. Of 243 patients who did not have any CSLs identified on colonoscopy +/- EGD, 75 underwent subsequent small bowel imaging, and 9 patients underwent small bowel imaging despite having a CSL found on endoscopy. A total of 84 patients underwent subsequent small bowel imaging (68 CT enterography, 13 small bowel follow-through, one MR enterography, one CT enteroclysis, and one push enteroscopy). In these 84 patients, only one relevant CSL was found (inflammatory bowel disease).Conclusions
Upper and lower endoscopy are valuable tools for diagnosing gastrointestinal tract lesions in individuals over the age of 50 with newly diagnosed iron deficiency anemia in the absence of overt bleeding. CT enterography and small bowel follow-through have limited utility in this setting.
Posttransplant Lymphoproliferative Disorder of the Small Bowel as an Unexpected Cause of Iron Deficiency Anemia Decades after Heart Transplantation