Joosten E, Ghesquiere B, Linthoudt H, Krekelberghs F, Dejaeger E, Boonen S, Flamaing J, Pelemans W, Hiele M, Gevers A M
Department of Physiopathology, University Hospitals K.U. Leuven, Belgium.
Am J Med. 1999 Jul;107(1):24-9. doi: 10.1016/s0002-9343(99)00162-x.
Iron deficiency anemia is commonly caused by chronic gastrointestinal blood loss, and a thorough examination of the gastrointestinal tract has become standard practice. In contrast, iron deficiency without anemia has hardly been studied, and its causes are less certain. The aim of the present study was to determine the diagnostic value of upper and lower gastrointestinal evaluation in elderly hospitalized patients with iron deficiency, irrespective of the hemoglobin level.
In a prospective study, 151 consecutive elderly patients with iron deficiency (serum ferritin level < 50 microg/L at two separate occasions) were investigated using esophagogastroduodenoscopy with colonoscopy (n = 90) or barium enema (n = 61).
A potential upper gastrointestinal tract lesion was found in 47 (49%) of the 96 anemic patients and in 31 (56%) of the 55 nonanemic patients (P = 0.38). Nonanemic patients had a greater prevalence of erosive gastritis or duodenitis. Anemic patients (72%) were more frequently investigated with a colonoscopy than nonanemic patients (38%, P = 0.001), and a lower gastrointestinal lesion was found in 32% of the anemic patients and 16% of the nonanemic patients (P = 0.03). Cancer was the most common lesion in the colon; 11 of the 18 patients were asymptomatic. Site-specific symptoms, fecal occult blood loss, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) were not associated with the detection of gastrointestinal lesions. In 9.5% of the patients with a benign upper gastrointestinal lesion, a synchronous colonic tumor was found.
Elderly patients with iron deficiency should undergo endoscopic examination, irrespective of the hemoglobin level. The presence of gastrointestinal symptoms, a positive fecal occult blood test, and the use of NSAIDs are of limited value in guiding the diagnostic procedure.
缺铁性贫血通常由慢性胃肠道失血引起，对胃肠道进行全面检查已成为标准做法。相比之下，缺铁但无贫血的情况几乎未被研究，其病因也不太明确。本研究的目的是确定上消化道和下消化道评估对老年缺铁住院患者的诊断价值，无论其血红蛋白水平如何。
在一项前瞻性研究中，对151例连续的老年缺铁患者（两次不同时间血清铁蛋白水平<50μg/L）进行了研究，其中90例采用食管胃十二指肠镜检查加结肠镜检查，61例采用钡剂灌肠。
96例贫血患者中有47例（49%）发现潜在的上消化道病变，55例非贫血患者中有31例（56%）发现潜在的上消化道病变（P = 0.38）。非贫血患者糜烂性胃炎或十二指肠炎的患病率更高。贫血患者接受结肠镜检查的频率（72%）高于非贫血患者（38%，P = 0.001），贫血患者中32%发现下消化道病变，非贫血患者中16%发现下消化道病变（P = 0.03）。结肠癌是结肠最常见的病变；18例患者中有11例无症状。特定部位的症状、粪便潜血和非甾体抗炎药（NSAIDs）的使用与胃肠道病变的检出无关。在9.5%的良性上消化道病变患者中，发现了同步性结肠肿瘤。
老年缺铁患者无论血红蛋白水平如何均应接受内镜检查。胃肠道症状、粪便潜血试验阳性和NSAIDs的使用对指导诊断程序的价值有限。
