Sánchez Martínez F, Vilà Santasuana A, Cid Pañella R, Gómez Vaquero C, Ortega Enciso L, Martínez Montauti J
Servicio de Medicina Interna, SCIAS, Hospital de Barcelona.
Gastroenterol Hepatol. 2000 May;23(5):219-23.
Chronic bleeding from the gastrointestinal tract is assumed to be the most common cause of iron deficiency anemia in men and in postmenopausal women.
The aim of this study was to assess the most frequent causes of chronic gastrointestinal bleeding in patients with iron deficiency anemia and to suggest a diagnostic endoscopic strategy that could be useful in clinical practice.
We studied 66 patients (48 women and 18 men), with a mean age of 73 who were admitted to our hospital from 1993 to 1996 because of unrelated signs and symptoms. Iron deficiency anemia was detected in a routine laboratory test. Patients had no symptoms of digestive disease. Children, pre-menopausal women and patients with a history of digestive disease of anemia of known origin were excluded. Diagnostic procedures included oral panendoscopy, colonoscopy and, in some cases, contrast radiology. In all patients follow-up was carried out between 3 and 36 months after discharge. Patients were considered to have improved when hemoglobin values were normal, according to standard laboratory values.
At least one lesion responsible for anemia was found in 46 patients (70%). Of these 46 patients, 31 presented a lesion in the upper digestive tract and 13 presented a lesion in the lower digestive tract. Colon cancer was diagnosed in eight patients and gastrointestinal cancer in one. In the remaining two patients, peptic ulcer and colo-rectal cancer were found simultaneously. A diagnosis of "minor" lesions was made in 15 patients (23%) and in five patients (7%) no lesions were found that could have caused the bleeding. Both groups (minor lesions and undiagnosed patients) improved with iron therapy.
Upper gastrointestinal lesions were the most frequent cause of iron-deficiency anemia, although colonoscopy is the best procedure for detecting gastrointestinal cancer and should be performed despite evident upper gastrointestinal bleeding.
胃肠道慢性出血被认为是男性和绝经后女性缺铁性贫血最常见的原因。
本研究旨在评估缺铁性贫血患者慢性胃肠道出血的最常见原因，并提出一种在临床实践中可能有用的诊断性内镜检查策略。
我们研究了66例患者（48例女性和18例男性），平均年龄73岁，他们在1993年至1996年因无关的体征和症状入住我院。缺铁性贫血在常规实验室检查中被发现。患者无消化系统疾病症状。排除儿童、绝经前女性以及有已知病因的贫血性消化系统疾病病史的患者。诊断程序包括口服全消化道内镜检查、结肠镜检查，在某些情况下还包括造影放射学检查。所有患者在出院后3至36个月进行随访。根据标准实验室值，当血红蛋白值正常时，患者被认为病情有所改善。
46例患者（70%）发现至少有一个导致贫血的病变。在这46例患者中，31例在上消化道有病变，13例在下消化道有病变。8例患者被诊断为结肠癌，1例为胃肠道癌。在其余2例患者中，同时发现消化性溃疡和结直肠癌。15例患者（23%）被诊断为“轻微”病变，5例患者（7%）未发现可导致出血的病变。两组（轻微病变患者和未确诊患者）经铁剂治疗后病情均有改善。
上消化道病变虽是缺铁性贫血最常见的原因，但结肠镜检查是检测胃肠道癌的最佳方法，即使存在明显的上消化道出血也应进行。
