Napal J J, Hernández J L, Alonso J, Casuso E
Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
Rev Clin Esp. 2009 Jun;209(6):265-9. doi: 10.1016/s0014-2565(09)71475-4.
Diagnosis of iron deficiency anemia (IDA) of probably gastrointestinal (GI) tract origin is a difficult task for the clinician.
To know the incidence of GI lesions in our setting; the possibility to predict cancer with clinical and laboratory parameters; the diagnostic utility of capsule endoscopy, and the follow-up in those patients.
We performed a prospective study in our Internal Medicine Department, from April 2005 to December 2007, of patients with IDA.
A total of 129 patients (42 men, 87 women) were studied. There was 27 (20.9%) malignancies (21 colon, 5 stomach, 1 esophagus ); 39 (30.2%) benign upper GI lesions; 12 (9.3%) benign lower GI disorders; 16(12.4%) synchronous GI lesions; 2 (1.6%) celiac sprue, and 33 (25.6%) without identifiable lesions. We found significant differences between patients with and without malignancy in NSAID use, weight loss, leukocyte and platelet count, and alkaline phosphatase levels. Diagnosis sensitivity of capsule endoscopy in obscure GI bleeding was 27%. We did not found any malignancy during the follow-up of patients without an initial diagnosis.
In IDA, colonoscopy (or contrast barium enema in certain circumstances) is the most important exploration to rule out malignancy. Only NSAID use is useful to exclude cancer. Patients without identifiable lesions have a favorable prognosis. A moderate frequency of synchronous lesions was found. We recommend a complete conventional GI endoscopic study if no evident bleeding lesion is found during the initial endoscopic procedure. Capsule endoscopy and celiac disease serology are useful in obscure gastrointestinal bleeding.
对于临床医生而言，诊断可能源于胃肠道（GI）的缺铁性贫血（IDA）是一项艰巨的任务。
了解我们所研究环境中胃肠道病变的发生率；利用临床和实验室参数预测癌症的可能性；胶囊内镜的诊断效用以及对这些患者的随访情况。
2005年4月至2007年12月，我们在本内科对缺铁性贫血患者进行了一项前瞻性研究。
共研究了129例患者（42例男性，87例女性）。其中有27例（20.9%）为恶性肿瘤（21例结肠癌，5例胃癌，1例食管癌）；39例（30.2%）为良性上消化道病变；12例（9.3%）为良性下消化道疾病；16例（12.4%）为同步性胃肠道病变；2例（1.6%）为乳糜泻，33例（25.6%）未发现可识别的病变。我们发现使用非甾体抗炎药、体重减轻、白细胞和血小板计数以及碱性磷酸酶水平在有恶性肿瘤和无恶性肿瘤的患者之间存在显著差异。胶囊内镜对不明原因胃肠道出血的诊断敏感性为27%。在未初步诊断出恶性肿瘤的患者随访期间未发现任何恶性肿瘤。
在缺铁性贫血中，结肠镜检查（或在某些情况下进行钡剂灌肠造影）是排除恶性肿瘤的最重要检查。只有使用非甾体抗炎药有助于排除癌症。未发现可识别病变的患者预后良好。发现同步性病变的频率适中。如果在初始内镜检查过程中未发现明显的出血病变，我们建议进行完整的传统胃肠道内镜检查。胶囊内镜和乳糜泻血清学检查对不明原因的胃肠道出血有用。
