Bosch Xavier, Montori Elisabet, Guerra-García Mar, Costa-Rodríguez Jaime, Quintanilla Mariano H, Tolosa-Chapasian Paula E, Moreno Pedro, Guasch Neus, López-Soto Alfons
Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Quick Diagnosis Unit, Department of Internal Medicine, Hospital Plató, Barcelona, Spain.
Dig Liver Dis. 2017 Apr;49(4):417-426. doi: 10.1016/j.dld.2016.12.013. Epub 2016 Dec 21.
Anemia is defined as hemoglobin below the cutoff of normal in studies examining the gastrointestinal (GI) tract in iron-deficiency anemia (IDA). Although the risk of GI cancer (GIC) increases as hemoglobin decreases, guidelines do not usually recommend hemoglobin thresholds for IDA investigation.
To elucidate whether underlying GI disorders explain the different hemoglobin values and clinical outcomes observed initially in IDA patients referred for GI workup, we prospectively investigated the diagnostic yield of a thorough GI examination in consecutive IDA adults with predefined hemoglobin <9g/dL and no extraintestinal bleeding.
4552 patients were enrolled over 10 years. 96% of 4038 GI lesions were consistent with occult bleeding disorders and 4% with non-bleeding disorders. Predominant bleeding disorders included upper GI ulcerative/erosive lesions (51%), GIC (15%), and angiodysplasias (12%). Diffuse angiodysplasias (45% of angiodysplasias) and GIC showed the lowest hemoglobin values (6.3 [1.5] and 6.4 [1.3]g/dL, respectively). While the spread (diffuse vs. localized) and number (<3 vs. ≥3) of angiodysplasias correlated with the degree of anemia, hemoglobin values were lower in GIC with vs. without ulcerated/friable lesions (6.0 [1.1] vs. 7.0 [1.2]g/dL, P<0.001).
Not only GIC but also diffuse angiodysplasias caused the most severe anemia in IDA with predefined hemoglobin values <9g/dL.
在缺铁性贫血（IDA）患者的胃肠道（GI）检查研究中，贫血被定义为血红蛋白低于正常临界值。尽管随着血红蛋白水平降低，胃肠道癌症（GIC）风险增加，但指南通常并不推荐针对IDA调查设定血红蛋白阈值。
为了阐明潜在的胃肠道疾病是否能解释最初转诊进行GI检查的IDA患者所观察到的不同血红蛋白值和临床结局，我们前瞻性地调查了连续的IDA成年患者（预定义血红蛋白<9g/dL且无肠外出血）进行全面GI检查的诊断率。
10年间共纳入4552例患者。4038例胃肠道病变中，96%与隐匿性出血性疾病相符，4%与非出血性疾病相符。主要出血性疾病包括上消化道溃疡性/糜烂性病变（51%）、GIC（15%）和血管发育异常（12%）。弥漫性血管发育异常（占血管发育异常的45%）和GIC的血红蛋白值最低（分别为6.3[1.5]和6.4[1.3]g/dL）。血管发育异常的范围（弥漫性与局限性）和数量（<3个与≥3个）与贫血程度相关，有溃疡/易碎病变的GIC患者血红蛋白值低于无此类病变的患者（6.0[1.1] vs. 7.0[1.2]g/dL，P<0.001）。
对于预定义血红蛋白值<9g/dL的IDA患者，不仅GIC，而且弥漫性血管发育异常导致了最严重的贫血。
