Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2012 Jun;42(6):658-64. doi: 10.1111/j.1445-5994.2012.02724.x.
Iron deficiency anaemia (IDA) is a marker of occult blood loss from gastrointestinal (GI) lesions and requires thorough GI evaluation.
This study aimed to determine frequency and findings of GI endoscopy in patients with IDA attending a tertiary hospital, and associations of endoscopy with patient and clinician-related factors and results of faecal occult blood tests (FOBT).
Retrospective audit of 621 subjects identified with definite and probable IDA (serum ferritin ≤ 15 ug/L and 16-50 µg/L respectively) between 1 January 2006 and 31 December 31 2008. Subjects were analysed as males >18 years and females ≥ 45 years of age with definite (group A, n= 180) or probable (group B, n= 353) IDA, and females <45 years of age with definite or probable IDA (group C, n= 88).
Endoscopy of any type was documented in 310 (50%) of patients with oesophagogastroduodenal endoscopy, and colonoscopy rates being significantly higher in group A patients (61% and 56% respectively) than in group B (39%, 37%) and group C (30%, 31%; P ≤ 0.01 for all comparisons). Endoscopy rates ranged from 96% of patients seeing gastroenterologists to 31% of those seeing nephrologists. In patients undergoing colonoscopy, cancer and high-risk adenomas were detected in 51 patients (20%), ranging from 27/100 (27%) of group A, 23/130 (18%) of group B and 1/27 (4%) of group C. Lesion prevalence was similar (19-24%) regardless of whether FOBT yielded positive or negative results or had not been performed.
Almost one in two patients with IDA were not documented as undergoing GI endoscopy. More intense guideline promulgation, improved endoscopy access and ongoing practice audits are required to improve endoscopy rates.
缺铁性贫血（IDA）是胃肠道（GI）病变隐性失血的标志物，需要进行彻底的 GI 评估。
本研究旨在确定在一家三级医院就诊的 IDA 患者进行 GI 内镜检查的频率和结果，并探讨内镜检查与患者和临床医生相关因素以及粪便潜血试验（FOBT）结果之间的关系。
对 2006 年 1 月 1 日至 2008 年 12 月 31 日期间确诊和可能的 IDA（血清铁蛋白分别≤15ug/L 和 16-50ug/L）的 621 例患者进行回顾性审核。将年龄大于 18 岁的男性和年龄大于或等于 45 岁的女性分为明确（A 组，n=180）或可能（B 组，n=353）IDA 患者，年龄小于 45 岁的女性分为明确或可能的 IDA（C 组，n=88）患者。
记录了 310 例（50%）患者进行了任何类型的内镜检查，其中 A 组患者行上消化道内镜检查和结肠镜检查的比例明显高于 B 组（分别为 61%和 56%）和 C 组（分别为 30%和 31%；所有比较均 P≤0.01）。内镜检查率从接受胃肠病学家治疗的患者的 96%到接受肾病学家治疗的患者的 31%不等。在接受结肠镜检查的患者中，发现 51 例（20%）患者有癌症和高危腺瘤，其中 A 组 27/100（27%），B 组 23/130（18%），C 组 1/27（4%）。无论 FOBT 结果是否为阳性或阴性，或者是否未进行 FOBT，病变的患病率相似（19-24%）。
近一半的 IDA 患者未记录有接受 GI 内镜检查。需要更加强化指南的推广、改善内镜检查的可及性并持续进行实践审查，以提高内镜检查率。
