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Güncel klavuzlar eşliğinde demir eksikliği olan hastalarda gastrointestinal endoskopik inceleme sonuçlarının değerlendirilmesi

Yıl 2021, Cilt 11, Sayı 6, 783 - 789, 20.11.2021
https://doi.org/10.16899/jcm.909457

Öz

Giriş: Erişkin hastalarda kronik kan kaybı ve demirin intestinal emilim bozukluğu demir eksikliğinin (DE) iki önemli nedenidir. Bu çalışmamızda demir eksikliği nedeniyle endoskopik inceleme yaptığımız hastaların demografik verilerini ve endoskopi bulgularımızı değerlendirdik. Gereç ve Yöntem:Çalışma retrospektif olarak dizayn edildi. Haziran 2017-Nisan 2020 tarihleri arasında hastanemiz endoskopi ünitesinde DE ve/veya DEA nedeniyle endoskopik inceleme yapılan hastalar veri tabanı taranarak bulundu. Aktif kanama bulgusu olan hastalar dışlandıktan sonra kalan 326 hasta değerlendirildi. Bulgular:Hastaların median yaşı 58’di. 182’si erkek (%55.8), 144’ü kadındı (%44.2). Hastaların %28,5’i (n=93) 50 yaş ve altında iken, %71,5’i (n=133) 50 yaşın üzerindeydi. %13,2’sine endoskopi (ÖGD), %2,5’ine kolonoskopi, %84,4’üne endoskopi+kolonoskopi (çift yönlü işlem) birlikte yapılmıştı. Yapılan endoskopik incelemeler sonrasında hastaların %69,3’ünde DE/DEA’ya neden olabilecek patolojik bulgular saptanırken %30,7’sinde DE/DEA’ya neden olabilecek sindirim kanalı patolojisi izlenmedi. Hastaların 12’sinde (%3,8) malignite saptandı. Endoskopik incelemeler esnasında DE/DEA’ya neden olabilecek herhangi bir patoloji saptanması; sadece ÖGD veya kolonoskopi yapılan hastalarla (%43,1) karşılaştırıldığında; çift yönlü inceleme yapılan hasta grubunda (%74,2) istatistiksel olarak daha fazlaydı (p<0,001). Ayrıca çift yönlü inceleme yapılan hastaların %17,5’inde hem alt hem de üst GİS’te DE/DEA’ya neden olabilecek eş zamanlı patoloji saptandı. Sonuç: Klavuzlarda önerildiği şekilde endoskopik incelemelerin çift yönlü yapılması, tek yönlü incelemelere göre tanısal etkinliği artırır.

Kaynakça

  • 1- Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–16.
  • 2- Dickey S, Rockey DC. The natural history of iron deficiency anemia. Am J Med Sci 2019;358:357–362.
  • 3- Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020;159:1085–1094.
  • 4- Ünal ÜH, Fidan C, Korkmaz M, Selçuk H. Gastrointestinal endoscopy findings in iron-deficient patients. The Turkish Journal of Academic Gastroenterology 2012; 3:113-16
  • 5- Majid S, Salih M, Wasaya R, Jafri M. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 2008;8:52.
  • 6- S Yaylacı, AB Genç, A Tamer, H Cinemre, Mİ Uslan. Endoscopic examination results in patients with iron deficiency anemia. Medical Journal of Kocaeli 2014; 2:16-19
  • 7- Cetinkaya ZA, Sezikli M, Güzelbulut F, Altınöz ME, Değirmenci A, Gökden Y, et al. Results of gastrointestinal endoscopic examinations in patients with iron defıciency anemia. Dicle Med J 2011;38(2):155-9
  • 8- DC Rockey, O Altayar, Y Falck-Ytter, D Kalmaz. AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020;159:1097–1119
  • 9- James MW, Chen CM, Goddard WP, et al. Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. Eur J Gastroenterol Hepatol 2005; 17:1197-203.
  • 10- Brady PG. Iron deficiency anemia: A call for aggresive diag¬nostic evaluation. Southern Medical J 2007;100(7):966-7.
  • 11- Karnam US, Felder LR, Raskin JB. Prevalence of occult celiac disease in patients with iron-deficiency anemia: a prospective study. South Med J. 2004 Jan;97(1):30-4. doi: 10.1097/01.SMJ.0000051059.23259.56).
  • 12- Hudak L, Jaraisy A, Haj S, et al. An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter 2017;22.
  • 13- Lee YC, Chiang TH, Chou CK, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology 2016;150:1113–1124 e5.
  • 14- Malfertheiner P, Megraud F, O’Morain C et al. Current con¬cepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56(6):772-81.
  • 15- Cardenas VM, Mulla ZD, Ortiz M, Graham DY. Iron de¬ficiency and Helicobacter pylori infection in the United States. Am J Epidemiol. 2006;163(1):127-34.
  • 16- Kaye PV, Garsed K, Ragunath K, et al. The clinical utility and diagnostic yield of routine gastric biopsies in the investigation of iron-deficiency anaemia: a case-control study. Am J Gastroenterol 2008;103:2883e9.
  • 17- Tovey FI, Godfrey JE, Lewin MR. A gastrectomy population: 25e30 years on. Postgrad Med J 1990;66:450e6.
  • 18- Beyan C, Beyan E, Kaptan K, Ifran A, Uzar AI. Post-gastrectomy anemia: evaluation of 72 cases with post-gastrectomy anemia. Hematology. 2007;12:81-84.
  • 19- Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001;53:620–627.

An evaluation of gastrointestinal endoscopic examination outcomes in patients with iron deficiency through guidelines

Yıl 2021, Cilt 11, Sayı 6, 783 - 789, 20.11.2021
https://doi.org/10.16899/jcm.909457

Öz

Introduction:Chronic blood loss and intestinal malabsorption of iron are two important causes of iron deficiency in adult patients.We evaluated the demographic data and endoscopy findings of patients who underwent endoscopic examination due to iron deficiency. Materials and Method:The study was designed retrospectively.The database of patients who underwent endoscopic examination due to ID and/or IDA in the endoscopy unit of our hospital between June 2017-April 2020 were found through the database scan. After exclusion of patients with active bleeding finding, remaining 326 patients were evaluated. Findings:Median age of the patients was 58 years. The participants included 182 males and 144 females. Ninety three patients were below 50 years of age whereas 133 patients were above 50 years of age. Endoscopy was performed in 13.2% of the patients; colonoscopy was performed in 2.5% of the patients; and endoscopy + colonoscopy (dual procedure) was performed in 84.4% of the patients. Endoscopic examinations revealed pathological findings that may cause ID/IDA in 69.3% of the patients; however, no gastrointestinal pathology that may cause ID/IDA was detected in 30.7% of the patients.Twelve patients were diagnosed with malign diseases. Detection of any pathology that may cause ID/IDA during endoscopic examinations was significantly more in the dual examination group when compared to patients who had EGD or colonoscopy (p<0.001). Furthermore, concomitant pathologies that may cause ID/IDA in both lower and upper GIS were detected in 17.5% of the patients in the dual examination group. Conclusion:Dual endoscopic examinations according to guideline recommendations increase diagnostic efficiency compared to one-sided examinations.

Kaynakça

  • 1- Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–16.
  • 2- Dickey S, Rockey DC. The natural history of iron deficiency anemia. Am J Med Sci 2019;358:357–362.
  • 3- Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020;159:1085–1094.
  • 4- Ünal ÜH, Fidan C, Korkmaz M, Selçuk H. Gastrointestinal endoscopy findings in iron-deficient patients. The Turkish Journal of Academic Gastroenterology 2012; 3:113-16
  • 5- Majid S, Salih M, Wasaya R, Jafri M. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 2008;8:52.
  • 6- S Yaylacı, AB Genç, A Tamer, H Cinemre, Mİ Uslan. Endoscopic examination results in patients with iron deficiency anemia. Medical Journal of Kocaeli 2014; 2:16-19
  • 7- Cetinkaya ZA, Sezikli M, Güzelbulut F, Altınöz ME, Değirmenci A, Gökden Y, et al. Results of gastrointestinal endoscopic examinations in patients with iron defıciency anemia. Dicle Med J 2011;38(2):155-9
  • 8- DC Rockey, O Altayar, Y Falck-Ytter, D Kalmaz. AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020;159:1097–1119
  • 9- James MW, Chen CM, Goddard WP, et al. Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. Eur J Gastroenterol Hepatol 2005; 17:1197-203.
  • 10- Brady PG. Iron deficiency anemia: A call for aggresive diag¬nostic evaluation. Southern Medical J 2007;100(7):966-7.
  • 11- Karnam US, Felder LR, Raskin JB. Prevalence of occult celiac disease in patients with iron-deficiency anemia: a prospective study. South Med J. 2004 Jan;97(1):30-4. doi: 10.1097/01.SMJ.0000051059.23259.56).
  • 12- Hudak L, Jaraisy A, Haj S, et al. An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter 2017;22.
  • 13- Lee YC, Chiang TH, Chou CK, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology 2016;150:1113–1124 e5.
  • 14- Malfertheiner P, Megraud F, O’Morain C et al. Current con¬cepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56(6):772-81.
  • 15- Cardenas VM, Mulla ZD, Ortiz M, Graham DY. Iron de¬ficiency and Helicobacter pylori infection in the United States. Am J Epidemiol. 2006;163(1):127-34.
  • 16- Kaye PV, Garsed K, Ragunath K, et al. The clinical utility and diagnostic yield of routine gastric biopsies in the investigation of iron-deficiency anaemia: a case-control study. Am J Gastroenterol 2008;103:2883e9.
  • 17- Tovey FI, Godfrey JE, Lewin MR. A gastrectomy population: 25e30 years on. Postgrad Med J 1990;66:450e6.
  • 18- Beyan C, Beyan E, Kaptan K, Ifran A, Uzar AI. Post-gastrectomy anemia: evaluation of 72 cases with post-gastrectomy anemia. Hematology. 2007;12:81-84.
  • 19- Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001;53:620–627.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Orhan COŞKUN (Sorumlu Yazar)
AMASYA ÜNİVERSİTESİ
0000-0002-3124-9517
Türkiye


Mustafa ÇAPRAZ
AMASYA ÜNİVERSİTESİ
0000-0001-9586-6509
Türkiye


Zeynep ÇETİN
AMASYA ÜNİVERSİTESİ
0000-0001-7824-4644
Türkiye

Destekleyen Kurum There is no financial disclosure.
Yayımlanma Tarihi 20 Kasım 2021
Kabul Tarihi 8 Ağustos 2021
Yayınlandığı Sayı Yıl 2021, Cilt 11, Sayı 6

Kaynak Göster

AMA Coşkun O. , Çapraz M. , Çetin Z. An evaluation of gastrointestinal endoscopic examination outcomes in patients with iron deficiency through guidelines. J Contemp Med. 2021; 11(6): 783-789.