Iron deficiency anaemia: are the British Society of Gastroenterology guidelines being adhered to?

BACKGROUND: The British Society of Gastroenterology (BSG) issued guidelines on the investigation of iron deficiency anaemia (IDA) ensuring standardised and comprehensive gastrointestinal investigation in all patients. It was apparent that not all patients in the authors' hospital were investigated according to these guidelines.
OBJECTIVE: To determine whether patients who were referred for upper gastrointestinal endoscopy for investigation of IDA were confirmed to be iron deficient, and whether the BSG guidelines were being fully implemented.
METHODS: All patients referred for upper gastrointestinal endoscopy over an 18 month period on a computer database (Endoscribe) were reviewed. Haematology, biochemistry, and radiology results were obtained and the frequency of the various diagnoses recorded.
RESULTS: A total of 320 patients (133 male; mean age 71.5 years) were initially referred for upper gastrointestinal endoscopy for investigation of IDA, of whom 95 were iron deficient. Of these, 44 (46%) had duodenal biopsies performed, three (7%) of whom were diagnosed with coeliac disease. Five patients were diagnosed with upper gastrointestinal carcinoma (one oesophageal, four gastric). Of the remaining 87 patients, 65 (75%) underwent lower gastrointestinal investigations with four having colorectal carcinoma, four colonic polyps, and one angiodysplasia.
CONCLUSIONS: Duodenal biopsies were performed in less than half of the patients. In those not diagnosed with coeliac disease or upper gastrointestinal carcinoma, only three quarters underwent lower gastrointestinal assessment. Approximately 10% were diagnosed with gastrointestinal malignancy as a cause for their anaemia and in 66% of patients no gastrointestinal cause was found. All physicians need to be made fully aware of the BSG guidelines for investigation of IDA.