Comparison of Gastrointestinal Endoscopy Findings in Male and Female Patients Evaluated with Diagnosis of Iron Deficiency Anemia: A Single-Center Retrospective Study

Öz

Background and aims: This study aimed to compare upper and lower gastrointestinal endoscopic findings in male and female patients diagnosed with iron deficiency anemia, in order to identify sex-specific diagnostic differences. Methods: A retrospective evaluation was conducted on 415 adult patients who underwent endoscopy between February 2022 and March 2025 for investigation of anemia etiology. Patients were divided into two groups based on sex; demographic characteristics, comorbidities, and endoscopic findings were statistically compared. Results: A total of 191 female and 224 male patients were included in the study. The rate of colorectal polyps was significantly higher in males compared to females (37.8% vs. 22.7%; p=0.003). The rates of colorectal malignancy were similar between the sexes; however, right-sided colonic tumors were more frequently observed in females (p=0.017). In upper gastrointestinal evaluations, reflux esophagitis and erosive gastritis were more common in males, whereas the rate of normal endoscopy findings was higher in females (21.8% vs. 10.3%; p=0.002). Gastric malignancies were detected only in male patients. Conclusion: In cases of iron deficiency anemia, upper and lower gastrointestinal endoscopic evaluations may reveal significant sex-specific diagnostic differences. While males have a higher prevalence of malignancy and premalignant lesions, right-sided colonic tumors are more prominent in females. These findings emphasize the importance of a sex-based approach in endoscopic screening and highlight the necessity of performing endoscopic procedures in all patients.

Anahtar Kelimeler

• iron deficiency anemia
• gastrointestinal endoscopy
• colorectal polyp
• sex differences
• colorectal cancer
• gastric malignancy

Demir Eksikliği Anemisi Tanısıyla Değerlendirilen Erkek ve Kadın Hastalarda Gastrointestinal Endoskopi Bulgularının Karşılaştırılması: Tek Merkezli Retrospektif Çalışma

Öz

Giriş ve amaç: Bu çalışma ile demir eksikliği anemisi tanısıyla üst ve alt gastrointestinal sistem endoskopisi yapılan erkek ve kadın hastalardaki bulguları karşılaştırarak, cinsiyete özgü tanısal farklılıkları ortaya koymak amaçlanmıştır. Metot: Şubat 2022 - Mart 2025 tarihleri arasında, anemi etiyolojisi araştırmak amacıyla endoskopi yapılan 415 erişkin hasta retrospektif olarak değerlendirildi. Hastalar cinsiyete göre iki gruba ayrıldı; demografik özellikler, komorbiditeler ve endoskopi bulguları istatistiksel olarak karşılaştırıldı. Bulgular: Çalışmaya 191 kadın ve 224 erkek hasta dahil edildi. Erkeklerde kolorektal polip oranı kadınlara göre anlamlı düzeyde yüksekti (%37.8 vs. %22.7; p=0.003). Kolorektal malignite oranları cinsiyetler arasında benzerdi, ancak sağ kolon tümörleri kadınlarda daha sık gözlendi (p=0.017). Üst gastrointestinal incelemelerde ise reflü özofajit ve eroziv gastrit erkeklerde daha yaygınken, kadınlarda normal endoskopi oranı daha yüksekti (%21.8 vs. %10.3; p=0.002). Gastrik maligniteler sadece erkek hastalarda saptandı. Sonuç: Demir eksikliği anemisi olgularında üst ve alt gastrointestinal endoskopik değerlendirme, cinsiyete özgü patolojilerin tanısında önemli farklılıklar gösterebilir. Erkeklerde malignite riski ve premalign lezyon prevelansı daha yüksekken, kadınlarda sağ kolon yerleşimli tümörler dikkat çekmektedir. Bu bulgular, endoskopik taramalarda cinsiyet temelli yaklaşımın önemini vurgulamakta, tüm hastalarda endoskopik işlem yapılması gerekliliğini ortaya koymaktadır.

Anahtar Kelimeler

• demir eksikliği anemisi
• gastrointestinal endoskopi
• kolorektal polip
• cinsiyet farklılığı
• kolorektal kanser
• gastrik malignite

Kaynakça

1. 1. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Accessed April 20, 2025. https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1
2. 2. Mortuza S, Chin-Yee B, James TE, et al. Myelodysplastic Neoplasms (MDS) with Ring Sideroblasts or SF3B1 Mutations: The Improved Clinical Utility of World Health Organization and International Consensus Classification 2022 Definitions, a Single-Centre Retrospective Chart Review. Curr Oncol. 2024;31(4):1762-73. doi:10.3390/curroncol31040134
3. 3. Majid S, Salih M, Wasaya R, Jafri W. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol. 2008;8:52. doi: 10.1186/1471-230X-8-52.
4. 4. Kim NH, Park JH, Park DI, et al. Should asymptomatic young men with iron deficiency anemia necessarily undergo endoscopy? Korean J Intern Med. 2018;33(6):1084-92. doi:10.3904/kjim.2016.421
5. 5. Fireman Z, Zachlka R, Abu Mouch S, Kopelman Y. The role of endoscopy in the evaluation of iron deficiency anemia in premenopausal women. Isr Med Assoc J IMAJ. 2006;8(2):88-90.
6. 6. Carter D, Levi G, Tzur D, Novis B, Avidan B. Prevalence and predictive factors for gastrointestinal pathology in young men evaluated for iron deficiency anemia. Dig Dis Sci. 2013;58(5):1299-305. doi: 10.1007/s10620-012-2496-6.
7. 7. Abu-Freha N, Gat R, Philip A, et al. Indications and Findings of Upper Endoscopies in Males and Females, Are They the Same or Different? J Clin Med. 2021;10(8):1620. doi:10.3390/jcm10081620
8. 8. 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(7):766-71. doi:10.1016/s0016-5107(04)00348-7

9. 9. Januszewicz W, Witczak K, Wieszczy P, et al. Prevalence and risk factors of upper gastrointestinal cancers missed during endoscopy: a nationwide registry-based study. Endoscopy. 2022;54(7):653-60. doi:10.1055/a-1675-4136
10. 10. Genç A. The retrospective analysis of hospitalized patiens in the internal medicine clinic because of anemia.Sakarya, Sakarya Üniversitesi, Eğitim ve Araştırma Hastanesi,2013.Ulusal Tez Merkezi | Anasayfa. Accessed April 20, 2025. https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=stJaZU5I56cR- PbjnlERKQ&no=vKWn21dZHos2IHFTwB11zg
11. 11. Özbalcı D, Kaplanoğlu E, Alanoğlu EG, Gürdal O. The Prevalance Of Iron Deficiency Anemia In Adults In Hospital Of Isparta Suleyman Demirel University And Evaluation Of Etiological Factors. Med J SDU 2021;28(1):57-65
12. 12. Kim SE, Paik HY, Yoon H, et al. Sex- and gender-specific disparities in colorectal cancer risk. World J Gastroenterol. 2015;21(17):5167-75. doi:10.3748/wjg.v21.i17.5167
13. 13. Choi Y, Kim N. Sex Difference of Colon Adenoma Pathway and Colorectal Carcinogenesis. World J Mens Health. 2024;42(2):256-82. doi:10.5534/wjmh.230085
14. 14. Massat NJ, Moss SM, Halloran SP, Duffy SW. Screening and primary prevention of colorectal cancer: a review of sex-specific and site-specific differences. J Med Screen. 2013;20(3):125-48. doi: 10.1177/0969141313501292.
15. 15. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. doi:10.3322/caac.21660
16. 16. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-81. doi:10.3322/caac.21457
17. 17. Herrera DJ, Van De Veerdonk W, Talboom S, et al. Shared decision-making tool development for colorectal cancer screening: A co-creative process with general practitioners and underserved people. Public Health. 2025;242:236-43. doi:10.1016/j.puhe.2025.02.029
18. 18. TOwards imProved screening for breast, cervical and colorectal cancer In All of EUrope. EU-topia. Accessed April 20, 2025. https://eu-topia.org/
19. 19. Goddard AF, James MW, McIntyre AS, et al. British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309-16. doi:10.1136/gut.2010.228874
20. 20. Carter D, Levi G, Tzur D, et al. Prevalence and Predictive Factors for Gastrointestinal Pathology in Young Men Evaluated for Iron Deficiency Anemia. Dig Dis Sci. 2013;58(5):1299-305. doi:10.1007/s10620-012-2496-6