ejm

Ege Tıp Dergisi

1016-9113 2147-6500

Ege University

10.19161/etd.915674

Health Care Administration

Sağlık Kurumları Yönetimi

Endoscopic findings in the older patients with iron-deficiency anemia

https://orcid.org/0000-0002-5787-3422

Şenkaya

Ali

Ege University Department of Internal Medicine, Division of Gastroenterology

https://orcid.org/0000-0003-4459-7657

Çelik

Ferit

Ege University Department of Internal Medicine, Division of Gastroenterology

https://orcid.org/0000-0002-6960-4043

Özütemiz

Ömer

Ege University Department of Internal Medicine, Division of Gastroenterology

04 19 2021

23 29 01 18 2021 03 15 2021

1962

Ege Journal of Medicine

Aim: The presence of iron-deficiency anemia, which is an important indication for endoscopicprocedures, in the geriatric population necessitates the exclusion of a possible malignancy in thegastrointestinal system. This study aims to examine endoscopic findings in geriatric patients thatunderwent esophagogastroduodenoscopy and colonoscopy because of iron-deficiency anemia.Materials and Methods: Sixty patients aged 65 and over who underwentesophagogastroduodenoscopy and colonoscopy because of iron-deficiency anemia between August2019 and August 2020 were retrospectively evaluated. Age, sex, geriatric age groups of patients,presence of Helicobacter pylori in gastric biopsy, esophagogastroduodenoscopy findings, colonoscopyfindings, presence of internal and / or external hemorrhoids, and duodenal biopsy results wereexamined.Results: Thirty (50%) of 60 patients included in the study were male and the mean age was 72.47 ±6.07 years. Of these patients, 41 (68.4%) were young-old, 17 (28.3%) were middle-old and 2 (3.3%)were old-old. The most common causes that might explain iron-deficiency anemia inesophagogastroduodenoscopy were atrophic gastritis (21.2%), Helicobacter pylori-positive gastritis(20%), gastric polyp (11.7%), and gastric cancer (3.3%), whereas colonoscopy results were foundcolon polyps in 23.3% of patients, diverticulum in 15% and angiodysplasia in 15%, and colon cancer in8.3%. Internal hemorrhoids were also observed in 44 (73.3%) patients.Conclusion: In the older population, blood loss from the gastrointestinal system is the most importantcause of iron-deficiency anemia and just hemorrhoids cannot explain IDA. While examining theetiology of patients diagnosed with iron-deficiency anemia, performing bothesophagogastroduodenoscopy and colonoscopy is an accurate approach to reach the underlyingcause and not to miss a possible malignancy

Iron-deficiency anemia older patient endoscopy colonoscopy

Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014; 123: 615–24.

National Center for Health Statistics, The Third National Health and Nutrition Survey (NHANES III, 1988– 1994). Reference Manuals and Reports. 1996.

Smith DL. Anemia in the Elderly. Am Fam Physician 2000; 62: 1565–72.

Joosten E, Pelemans W, Hiele M, et al. Prevalence and causes of anemia in a geriatric hospitalized population. Gerontology 1992; 38: 111–7.

Milman N. Anemia--still a major health problem in many parts of the world! Ann Hematol 2011; 90: 369-77.

Gunter EW, Lewis BG, Koncikowski SM. Laboratory procedures used for the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. US Dep Heal Hum Serv Public Heal Serv Centers Dis Control Prev Natl Cent Environ Heal Atlanta, GA, Natl Cent Heal Stat Hyattsville, MD. 1996.

Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal bleeding. Am Fam Physician 2013; 87: 430-6.

Liu K, Kaffes AJ. Iron deficiency anaemia: a review of diagnosis, investigation and management. Eur J Gastroenterol Hepatol 2012; 24: 109-16.

WHO (1972) Psychogeriatric, report of a WHO Scientific Group, Technical Reports Series 507, Geneva. Cited in Davise AM. Epidemiology 185; 14 (1): 9-21.

Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012; 19: 133–40.

Capurso G, Baccini F, Osborn J, et al. Can patient characteristics predict the outcome of endoscopic evaluation of iron deficiency anemia: a multiple logistic regression analysis. Gastrointest Endosc 2004; 59: 766–71.

Annibale B, Capurso G, Chistolini A, et al. Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms. Am J Med 2001; 111: 439–45.

Rockey DC. Occult gastrointestinal bleeding. Gastroenterol Clin N Am 2005; 34: 699–718.

Stephens MR, Hopper AN, White SR, et al. Colonoscopy first for iron-deficiency anemia: a number needed to investigate approach. Q J Med 2006; 99: 389–95.

Zuckerman G, Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol 1992; 87: 62–6.

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: 1963–7.

Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal bleeding. Am Fam Physician 2013; 87: 430-6. 2021; Volume / Cilt: 60 (Supplement / Ek Sayı) 29

American Gastroenterological Association medical position statement: evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118: 197–201.

Fisher L, Lee Krinsky M, et al. The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc 2010; 72: 471–9.

Coban E, Timuragaoglu A, Meriç M. Iron deficiency anemia in the elderly: prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Acta Haematol 2003; 110 (1): 25-8.

Luman W, Ng KL. Audit of investigations in patients with iron deficiency anaemia. Singapore Med J 2003; 44: 504–10.

Lindsay JO, Robinson SD, Jackson JE, et al. The investigation of iron deficiency anemia—a hospital based audit. Hepatogastroenterology 1999; 46: 2887–90.

Majid S, Salih M, Wasaya R, et al. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 2008; 8: 52.

Ünal ÜH, Fidan C, Korkmaz M, Selçuk H. Demir eksikliği olan hastalarda gastrointestinal sistem endoskopi bulguları. Akademik Gastroenteroloji Dergisi 2012; 3: 113-6

Yaylacı S, Genç AB, Tamer A, Cinemre H, Uslan Mİ. Demir eksikliği anemisi nedeniyle takipli hastalarda endoskopi sonuçları. Kocaeli Tıp Dergisi 2014; 2: 16-9.

Yüksel M, Saka B, Vatansever S. Yaşlılarda demir eksikliği anemisi etyolojisinin ve sıklığının saptanması İç Hastalıkları Dergisi 2012; 19: 87-97.

Vannella L, Aloe Spiriti MA, Di Giulio E, et al. Upper and lower gastrointestinal causes of iron deficiency anemia in elderly compared with adult outpatients. Minerva Gastroenterol Dietol 2010; 56: 397-404.

Zhu A, Kaneshiro M, Kaunitz JD. Evaluation and treatment of iron deficiency anemia: a gastroenterological perspective. Dig Dis Sci 2010; 55: 548-59.

Bermejo F, García-López S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol 2009; 15: 4638-43.

Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27 (2): 215–20.

Tamer A, Korkut E, Korkmaz U, Akcan Y. Alt gastrointestinal endoskopi sonuclarımız: Duzce bolgesi. The Medical Journal of Kocatepe 2005; 6: 29-31.

Okuturlar Y, Soylu A, İnan Y, ve ark. Demir eksikliği anemisi olan hastalarda alt ve üst gastrointestinal endoskopik inceleme sonuçları. Endoskopi Gastrointestinal 2014; 22 (2): 33-7