Droogendijk Jolanda, Beukers Ruud, Berendes Paul B, Tax Martine G H M, Sonneveld Pieter, Levin Mark-David
Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands.
Scand J Gastroenterol. 2011 Sep;46(9):1105-10. doi: 10.3109/00365521.2011.594082. Epub 2011 Jul 4.
The prevalence of iron deficiency anemia (IDA) is 2-5% in men and postmenopausal women in the developed world. IDA is commonly caused by chronic gastrointestinal blood loss, and a thorough examination of the gastrointestinal tract must be standard practice.
To retrospectively study endoscopic evaluations of patients from general practitioners diagnosed with IDA in a peripheral hospital laboratory in order to determine the cause of IDA and the number of gastrointestinal malignancies.
We retrospectively evaluated all patients with IDA diagnosed in a peripheral hospital laboratory by the general practitioner in the region of our hospital from 1 January 2004 until 31 December 2005. We included women older than 50 and men 18 years and older without a history of IDA in the previous 2 years.
In 2 years, 287 patients were newly diagnosed with IDA in our hospital laboratory. Only 90 (31%) patients were endoscopically evaluated within 4 months. Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 41 of 90 (46%) patients. The most common lesions identified by gastroduodenal endoscopy were erosive esophagitis, gastritis and duodenitis (14%). Cancer was the most commonly detected lesion in the colon, accounting for 17 of 21 colonic lesions explaining IDA. In total, gastrointestinal malignancy was diagnosed in 2% of screened patients. Factors determining the decision for endoscopic screening were lower hemoglobin level, lower ferritin level and male gender.
In our retrospective study of patients with IDA, only 31% received any form of endoscopic evaluation. In general practice, IDA is investigated suboptimally, and interventions other than the issuing of guidelines are needed to change practice.
在发达国家，缺铁性贫血（IDA）在男性和绝经后女性中的患病率为2%-5%。IDA通常由慢性胃肠道失血引起，因此对胃肠道进行全面检查必须成为标准做法。
回顾性研究在一家外围医院实验室被全科医生诊断为IDA的患者的内镜检查情况，以确定IDA的病因及胃肠道恶性肿瘤的数量。
我们回顾性评估了2004年1月1日至2005年12月31日期间在我院所在地区的一家外围医院实验室被全科医生诊断为IDA的所有患者。我们纳入了年龄在50岁以上的女性以及年龄在18岁及以上且在过去两年内无IDA病史的男性。
在两年时间里，我院实验室新诊断出287例IDA患者。仅有90例（31%）患者在4个月内接受了内镜检查。胃肠道内镜检查显示，90例患者中有41例（46%）至少存在一处可能导致失血的病变。胃十二指肠内镜检查发现的最常见病变为糜烂性食管炎、胃炎和十二指肠炎（14%）。结肠癌是在结肠中最常检测到的病变，在解释IDA的21处结肠病变中有17处为结肠癌。总体而言，在接受筛查的患者中，2%被诊断为胃肠道恶性肿瘤。决定进行内镜筛查的因素包括血红蛋白水平较低、铁蛋白水平较低以及男性性别。
在我们对IDA患者的回顾性研究中，只有31%的患者接受了任何形式的内镜检查。在一般医疗实践中，对IDA的调查并不理想，需要采取除发布指南之外的干预措施来改变这种情况。
