Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Korea.
Intern Med J. 2009 Jul;39(7):441-6. doi: 10.1111/j.1445-5994.2008.01785.x. Epub 2008 Aug 15.
Although endoscopy is recommended for patients with iron deficiency anaemia, there is, currently, no consensus on the role of endoscopy for iron-deficient patients without anaemia. The goal of this study was to determine the prevalence of serious gastrointestinal (GI) lesions, identified by endoscopy in patients with iron deficiency and anaemia compared with patients with iron deficiency without anaemia.
One thousand five hundred and eighteen patients with a ferritin value of <or=50 ng/mL and a total iron-binding capacity >or=300 mg/dL were retrospectively investigated using oesophagogastroduodenoscopy and colonoscopy between January 2005 and September 2006. The lesions identified were classified as clinically important according to standard predetermined criteria.
Among the 1518 cases, 749 patients had anaemia and 769 had normal haemoglobin levels. Clinically important lesions were identified in 24.6% of the patients with anaemia and in 22.8% of the patients without anaemia (P > 0.05). The frequency of lower GI tract lesions (13.6 vs 11.4%, P > 0.05) and upper GI tract lesions (11.9 vs 12.5%, P > 0.05) was similar in the comparisons between the two groups. However, the frequency of malignant GI lesions was higher in the patients with anaemia (5.1 vs 0.7%, P < 0.01). In addition, the patients without anaemia were significantly more likely to have early-stage neoplasia (adenoma, early gastric cancer and Dukes' A and B colon cancer) than were the patients with anaemia (98.4 vs 52.5%, P < 0.01).
The results of this study suggest that patients with iron deficiency should undergo endoscopic evaluation of the GI tract, irrespective of whether they have anaemia. The endoscopic evaluation of the GI tract in patients with iron deficiency without anaemia could provide an opportunity for the detection of early-stage neoplasia at a curable stage.
尽管内镜检查被推荐用于缺铁性贫血患者，但对于无贫血的缺铁患者，内镜检查的作用目前尚未达成共识。本研究旨在确定通过内镜检查在缺铁伴贫血患者与缺铁无贫血患者中发现严重胃肠道（GI）病变的患病率。
回顾性分析 2005 年 1 月至 2006 年 9 月间 1518 例铁蛋白值<或=50ng/mL 且总铁结合能力>或=300mg/dL 的患者，行上消化道内镜和结肠镜检查。根据标准预定标准，将发现的病变分类为具有临床意义。
在 1518 例患者中，749 例患者有贫血，769 例患者血红蛋白水平正常。贫血患者中，有临床意义的病变发生率为 24.6%，无贫血患者为 22.8%（P>0.05）。下消化道病变（13.6%比 11.4%，P>0.05）和上消化道病变（11.9%比 12.5%，P>0.05）的发生率在两组之间相似。然而，贫血患者恶性 GI 病变的发生率更高（5.1%比 0.7%，P<0.01）。此外，无贫血患者发生早期肿瘤（腺瘤、早期胃癌和 Dukes A 和 B 期结肠癌）的可能性明显高于贫血患者（98.4%比 52.5%，P<0.01）。
本研究结果表明，无论患者是否贫血，均应进行胃肠道内镜评估。对无贫血的缺铁患者进行胃肠道内镜评估可能为发现可治愈阶段的早期肿瘤提供机会。
