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Long-Term Outcomes and Prognostic Factors for Patients with Endoscopy-Negative Iron Deficiency

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Abstract

Background and Aim

Iron deficiency anemia (IDA) is a common problem among the elderly, and often no cause is identified after routine upper endoscopy and colonoscopy exams. The purpose of this study was to determine the long-term outcomes and predictors of gastrointestinal pathology and death in patients with endoscopy-negative IDA.

Methods

This was a retrospective review of consecutive endoscopy negative-IDA patients during 2002–2004 at the VA San Diego Healthcare System.

Results

Mean age was 69.3 years (range 42–93), and included 105 men and nine women. Mean length of follow-up was 65.1 months. IDA resolved in 56 patients. None of these patients developed evidence of any clinically significant gastrointestinal pathology. The remaining 58 patients had persistent anemia (n = 47) or recurrent anemia (n = 11). Only 2/47 patients with persistent anemia were found to have clinically significant but benign gastrointestinal pathology during follow-up. In contrast, 6/11 patients with recurrent anemia were subsequently found to have gastrointestinal pathology. Deaths during follow-up occurred in 7 (12.5 %) patients with resolved anemia, compared with 20 (34.5 %) patients with recurrent or persistent anemia (p = 0.006). Significant independent predictors of death included persistent or recurrent anemia, anti-platelet or anticoagulant use, and congestive heart failure.

Conclusions

Patients with iron deficiency anemia and negative upper endoscopy and colonoscopy often have a favorable outcome, especially if the anemia resolves with treatment. In patients with recurrent anemia a malignancy within reach of standard endoscopy and colonoscopy are possible, and repeating these procedures is warranted before consideration of further investigations.

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References

  1. Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med. 1993;329:1691–1695.

    Article  PubMed  CAS  Google Scholar 

  2. Kepczyk MT, Kadakia CS. Prospective evaluation of gastrointestinal tract in patients with iron deficiency anemia. Dig Dis Sci. 1995;40:1283–1289.

    Article  PubMed  CAS  Google Scholar 

  3. McIntyre AS, Long RG. Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut. 1993;34:1102–1107.

    Article  PubMed  CAS  Google Scholar 

  4. Gordon SR, Smith RE, Power GC. The role of endoscopy in the evaluation of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol. 1994;89:1963–1967.

    PubMed  CAS  Google Scholar 

  5. Goddard AF, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. Gut 2000;46:IV1–IV5.

    Google Scholar 

  6. Sahay R, Scott BB. Iron deficiency anaemia—how far to investigate? Gut. 1993;34:1427–1428.

    Article  PubMed  CAS  Google Scholar 

  7. Gordon S, Bensen S, Smith R. Long-term follow-up of older patients with iron deficiency anemia after a negative GI evaluation. Am J Gastroenterol. 1996;91:885–889.

    PubMed  CAS  Google Scholar 

  8. McLoughlin MT, Tham TC. Long-term follow-up of patients with iron deficiency anaemia after a negative gastrointestinal evaluation. Eur J Gastroenterol Hepatol. 2009;21:872–876.

    Article  PubMed  Google Scholar 

  9. Chao HH, Schwartz AR, Hersh J, et al. Improving colorectal cancer screening and care in the Veterans Affairs Healthcare system. Clin Colorectal Cancer. 2009;8:22–28.

    Article  PubMed  Google Scholar 

  10. Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at veterans affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000;160:3252–3257.

    Article  PubMed  CAS  Google Scholar 

  11. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.

    Article  PubMed  CAS  Google Scholar 

  12. Lee RH, Tang RS, Muthusamy VR, et al. Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos). Gastrointest Endosc. 2011;74:128–134.

    Article  PubMed  Google Scholar 

  13. Kilgore TW, Abdinoor AA, Szary NM, et al. Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc. 2011;73:1240–1245.

    Article  PubMed  Google Scholar 

  14. Moch A, Herlinger H, Kochman ML, et al. Enteroclysis in the evaluation of obscure gastrointestinal bleeding. AJR Am J Roentgenol. 1994;163:1381–1384.

    PubMed  CAS  Google Scholar 

  15. Apostolopoulos P, Liatsos C, Gralnek IM, et al. The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. Endoscopy. 2006;38:1127–1132.

    Article  PubMed  CAS  Google Scholar 

  16. Sheibani S, Levesque BG, Friedland S, et al. Long-term impact of capsule endoscopy in patients referred for iron-deficiency anemia. Dig Dis Sci. 2010;55:703–708.

    Article  PubMed  CAS  Google Scholar 

  17. Milano A, Balatsinou C, Filippone A, et al. A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis. Gastrointest Endosc. 2011;73:1002–1008.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by NIH#DK090506 (SBH). Additional resources were provided by the Research Service, VA San Diego Healthcare System, San Diego, CA.

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Correspondence to Samuel B. Ho.

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Soon, A., Cohen, B.L., Groessl, E.J. et al. Long-Term Outcomes and Prognostic Factors for Patients with Endoscopy-Negative Iron Deficiency. Dig Dis Sci 58, 488–495 (2013). https://doi.org/10.1007/s10620-012-2368-0

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  • DOI: https://doi.org/10.1007/s10620-012-2368-0

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