Department of Medicine, Gastroenterology (111D), VA San Diego Healthcare System and University of California, San Diego, 3550 La Jolla Village Drive, San Diego, CA 92161, USA.
Dig Dis Sci. 2013 Feb;58(2):488-95. doi: 10.1007/s10620-012-2368-0. Epub 2012 Sep 4.
Iron deficiency anemia (IDA) is a common problem among the elderly, and often no cause is identified after routine upper endoscopy and colonoscopy exams. The purpose of this study was to determine the long-term outcomes and predictors of gastrointestinal pathology and death in patients with endoscopy-negative IDA.
This was a retrospective review of consecutive endoscopy negative-IDA patients during 2002-2004 at the VA San Diego Healthcare System.
Mean age was 69.3 years (range 42-93), and included 105 men and nine women. Mean length of follow-up was 65.1 months. IDA resolved in 56 patients. None of these patients developed evidence of any clinically significant gastrointestinal pathology. The remaining 58 patients had persistent anemia (n = 47) or recurrent anemia (n = 11). Only 2/47 patients with persistent anemia were found to have clinically significant but benign gastrointestinal pathology during follow-up. In contrast, 6/11 patients with recurrent anemia were subsequently found to have gastrointestinal pathology. Deaths during follow-up occurred in 7 (12.5 %) patients with resolved anemia, compared with 20 (34.5 %) patients with recurrent or persistent anemia (p = 0.006). Significant independent predictors of death included persistent or recurrent anemia, anti-platelet or anticoagulant use, and congestive heart failure.
Patients with iron deficiency anemia and negative upper endoscopy and colonoscopy often have a favorable outcome, especially if the anemia resolves with treatment. In patients with recurrent anemia a malignancy within reach of standard endoscopy and colonoscopy are possible, and repeating these procedures is warranted before consideration of further investigations.
缺铁性贫血（IDA）是老年人常见的问题，在上消化道内镜和结肠镜检查后，经常无法确定病因。本研究旨在确定内镜阴性 IDA 患者的胃肠道病理和死亡的长期结局和预测因素。
这是 2002-2004 年期间在 VA 圣地亚哥医疗保健系统进行的连续内镜阴性 IDA 患者的回顾性研究。
平均年龄为 69.3 岁（范围 42-93），包括 105 名男性和 9 名女性。平均随访时间为 65.1 个月。56 例患者 IDA 缓解。这些患者均未出现任何有临床意义的胃肠道病理证据。其余 58 例患者持续贫血（n=47）或复发性贫血（n=11）。持续贫血的 47 例患者中仅 2 例在随访期间发现有临床意义但良性的胃肠道病理。相比之下，复发性贫血的 11 例患者中有 6 例随后发现有胃肠道病理。在随访期间，7 例（12.5%）缓解性贫血患者死亡，而 20 例（34.5%）复发性或持续性贫血患者死亡（p=0.006）。死亡的显著独立预测因素包括持续或复发性贫血、抗血小板或抗凝药物使用以及充血性心力衰竭。
上消化道内镜和结肠镜检查阴性的缺铁性贫血患者通常预后良好，尤其是贫血在治疗后缓解的患者。对于复发性贫血患者，标准内镜和结肠镜检查可触及的恶性肿瘤是可能的，在考虑进一步检查之前，重复这些检查是合理的。
