Schilling D, Grieger G, Weidmann E, Adamek H E, Benz C, Riemann J F
Department of Internal Medicine C (Gastroenterology and Hepatology), Klinikum der Stadt Ludwigshafen, Academical Teaching Hospital, University of Mainz.
Z Gastroenterol. 2000 Oct;38(10):827-31. doi: 10.1055/s-2000-9999.
In patients with Iron Deficiency Anemia (IDA) occult gastrointestinal bleeding is generally investigated by bidirectional endoscopy. The aim of our study was to examine the long-term follow-up of patients with IDA where the sources of bleeding couldn't be detected despite close endoscopic and radiologic examination of the GI tract.
Based on the endoscopic data base we examined consecutive patients who were referred for gastrointestinal endoscopy due to IDA with a negative endoscopic (upper GI endoscopy and colonoscopy) evaluation. Further diagnostic work up (repeated endoscopy of the upper and lower GI tract by an experienced investigator, small bowel enteroclysis, push enteroscopy, proctoscopy, intraoperative enteroscopy, angiography, scintigraphic examinations) was recorded. The eligible patients were divided into 2 groups: Group 1 (no identification of the source of bleeding in the GI tract); group 2 (source of gastrointestinal blood loss was found). Long-term follow-up was performed by telephone interview with patients and/or with their general practitioner.
79 patients (mean age 58.8 years [17-83, 44] female) with IDA met the inclusion criteria. In 42 patients (53%) the endoscopic and radiographic evaluation was unable to find the source of gastrointestinal blood loss. 29 of these patients (69%) showed a resolved anemia after a mean follow-up of 48 months (18 months-5 years). 10 patients had a mild anemia, 3 required blood transfusions. In group one Helicobacter pylori infection was significantly more prevalent in comparison with group 2 (57% vs. 38%, p = 0.032).
Based on our data, the prognosis of IDA with negative endoscopy is favorable. The pathogenic role of Helicobacter pylori infection should be evaluated in further studies.
对于缺铁性贫血（IDA）患者，通常通过双向内镜检查来排查隐匿性胃肠道出血。我们研究的目的是，对那些尽管对胃肠道进行了仔细的内镜和放射学检查，但仍未检测到出血源的IDA患者进行长期随访。
基于内镜数据库，我们检查了因IDA接受胃肠道内镜检查且内镜检查（上消化道内镜检查和结肠镜检查）结果为阴性的连续患者。记录了进一步的诊断检查（由经验丰富的检查者对上、下消化道进行重复内镜检查、小肠灌肠造影、推进式小肠镜检查、直肠镜检查、术中肠镜检查、血管造影、闪烁扫描检查）。符合条件的患者分为两组：第1组（未确定胃肠道出血源）；第2组（发现胃肠道失血源）。通过电话采访患者和/或其全科医生进行长期随访。
79例IDA患者（平均年龄58.8岁[17 - 83岁，44例女性]）符合纳入标准。42例患者（53%）的内镜和影像学评估未能找到胃肠道失血源。这些患者中有29例（69%）在平均随访48个月（18个月 - 5年）后贫血症状得到缓解。10例患者有轻度贫血，3例需要输血。与第2组相比，第1组幽门螺杆菌感染明显更普遍（57%对38%，p = 0.032）。
根据我们的数据，内镜检查结果为阴性的IDA患者预后良好。幽门螺杆菌感染的致病作用应在进一步研究中进行评估。
