J J Napal1, J L Hernández, J Alonso, E Casuso. 1. Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España. napalj@terra.es
Abstract
BACKGROUND: Diagnosis of iron deficiency anemia (IDA) of probably gastrointestinal (GI) tract origin is a difficult task for the clinician. OBJECTIVE: To know the incidence of GI lesions in our setting; the possibility to predict cancer with clinical and laboratory parameters; the diagnostic utility of capsule endoscopy, and the follow-up in those patients. PATIENTS AND METHOD: We performed a prospective study in our Internal Medicine Department, from April 2005 to December 2007, of patients with IDA. RESULTS: A total of 129 patients (42 men, 87 women) were studied. There was 27 (20.9%) malignancies (21 colon, 5 stomach, 1 esophagus ); 39 (30.2%) benign upper GI lesions; 12 (9.3%) benign lower GI disorders; 16(12.4%) synchronous GI lesions; 2 (1.6%) celiac sprue, and 33 (25.6%) without identifiable lesions. We found significant differences between patients with and without malignancy in NSAID use, weight loss, leukocyte and platelet count, and alkaline phosphatase levels. Diagnosis sensitivity of capsule endoscopy in obscure GI bleeding was 27%. We did not found any malignancy during the follow-up of patients without an initial diagnosis. CONCLUSIONS: In IDA, colonoscopy (or contrast barium enema in certain circumstances) is the most important exploration to rule out malignancy. Only NSAID use is useful to exclude cancer. Patients without identifiable lesions have a favorable prognosis. A moderate frequency of synchronous lesions was found. We recommend a complete conventional GI endoscopic study if no evident bleeding lesion is found during the initial endoscopic procedure. Capsule endoscopy and celiac disease serology are useful in obscure gastrointestinal bleeding.
BACKGROUND: Diagnosis of iron deficiency anemia (IDA) of probably gastrointestinal (GI) tract origin is a difficult task for the clinician. OBJECTIVE: To know the incidence of GI lesions in our setting; the possibility to predict cancer with clinical and laboratory parameters; the diagnostic utility of capsule endoscopy, and the follow-up in those patients. PATIENTS AND METHOD: We performed a prospective study in our Internal Medicine Department, from April 2005 to December 2007, of patients with IDA. RESULTS: A total of 129 patients (42 men, 87 women) were studied. There was 27 (20.9%) malignancies (21 colon, 5 stomach, 1 esophagus ); 39 (30.2%) benign upper GI lesions; 12 (9.3%) benign lower GI disorders; 16(12.4%) synchronous GI lesions; 2 (1.6%) celiac sprue, and 33 (25.6%) without identifiable lesions. We found significant differences between patients with and without malignancy in NSAID use, weight loss, leukocyte and platelet count, and alkaline phosphatase levels. Diagnosis sensitivity of capsule endoscopy in obscure GI bleeding was 27%. We did not found any malignancy during the follow-up of patients without an initial diagnosis. CONCLUSIONS: In IDA, colonoscopy (or contrast barium enema in certain circumstances) is the most important exploration to rule out malignancy. Only NSAID use is useful to exclude cancer. Patients without identifiable lesions have a favorable prognosis. A moderate frequency of synchronous lesions was found. We recommend a complete conventional GI endoscopic study if no evident bleeding lesion is found during the initial endoscopic procedure. Capsule endoscopy and celiac disease serology are useful in obscure gastrointestinal bleeding.