Pongprasobchai Supot, Sriprayoon Tassanee, Manatsathit Sathaporn
Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Nov;94(11):1321-6.
Occult bleeding from the gastrointestinal (GI) lesions is a common cause of iron deficiency anemia (IDA). The information concerning the prevalence and the appropriate strategy for evaluation of IDA in Thai patients is scanty.
Prospectively evaluate Thai patients with IDA for GI lesions using bidirectional endoscopy
Consecutive patients with IDA were investigated by esophagogastroduodenoscopy (EGD) and colonoscopy. Significant GI lesions were identified. Clinical data and results of the fecal occult blood testing (FOBT) were collected to determine factors associated with the presence of GI lesions.
One hundred three patients were included in this study and the mean age was 63.6 +/- 15.2 years old. Significant GI lesions were detected in 58 patients (56%), 43% by EGD, 25% by colonoscopy. Twelve patients (12%) had dual lesions identified from both EGD and colonoscopy The most common lesions were peptic ulcers (22%) and colonic carcinoma (13%). Anti-platelets use and positive FOBT were associated with the significant GI lesions with odds ratios of 2.37 (95% CI 1.05-5.36, p = 0.036) and 2.83 (95% CI 1.05-7.68, p = 0.038), respectively FOBT had sensitivity, specificity, positive predictive value, and negative predictive value for significant GI lesions at 81%, 40%, 68%, and 66%, respectively. Site-specific symptoms correctly guided the route of endoscopy in 60-80% of the patients.
EGD resulted in a better yield than colonoscopy and was the preferred route of initial endoscopy unless there was suggestive site-specific symptom. Bidirectional endoscopy was finally required in most patients unless a cancerous lesion was detected by the initial endoscopy.
胃肠道（GI）病变引起的隐匿性出血是缺铁性贫血（IDA）的常见原因。关于泰国患者IDA的患病率及合适评估策略的信息较少。
采用双向内镜对泰国IDA患者的胃肠道病变进行前瞻性评估。
对连续性IDA患者进行食管胃十二指肠镜检查（EGD）和结肠镜检查，确定显著的胃肠道病变。收集临床资料和粪便潜血试验（FOBT）结果，以确定与胃肠道病变存在相关的因素。
本研究纳入103例患者，平均年龄为63.6±15.2岁。58例患者（56%）检测到显著的胃肠道病变，其中43%通过EGD检测到，25%通过结肠镜检查检测到。12例患者（12%）在EGD和结肠镜检查中均发现有双重病变。最常见的病变是消化性溃疡（22%）和结肠癌（13%）。使用抗血小板药物和FOBT阳性与显著的胃肠道病变相关，比值比分别为2.37（95%CI 1.05 - 5.36，p = 0.036）和2.83（95%CI 1.05 - 7.68，p = 0.038）。FOBT对显著胃肠道病变的敏感性、特异性、阳性预测值和阴性预测值分别为81%、40%、68%和66%。特定部位的症状在60 - 80%的患者中正确指导了内镜检查的途径。
EGD的检出率高于结肠镜检查，是初始内镜检查的首选途径，除非有提示特定部位的症状。大多数患者最终需要双向内镜检查，除非初始内镜检查发现癌性病变。
