Annibale B, Lahner E, Chistolini A, Gallucci C, Di Giulio E, Capurso G, Luana O, Monarca B, Fave G Delle
a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
Scand J Gastroenterol. 2003 Mar;38(3):239-245. doi: 10.1080/00365520310000690a.
In premenopausal women, iron-deficiency anaemia is common and menstrual flow is often held responsible, but it is not clear whether these women should be submitted to gastrointestinal (GI) evaluation. We aim to prospectively investigate whether premenopausal women with iron-deficiency anaemia benefit from GI evaluation regardless of menstrual flow.
The study population comprised 59 consecutive premenopausal women with iron-deficiency anaemia. Excluded were women with obvious or suspected causes of anaemia and those ≤21 years. Heavy menstrual loss was not considered an exclusion criterion. All subjects had: complete blood count, ferritin, non-invasive testing by faecal occult blood (FOB), C-urea breath test (C-UBT), anti-tissue transglutaminase antibodies (tTG) and gastrin levels. Gastroscopy with antral (n = 3), corporal (n = 3) and duodenal (n = 2) biopsies was performed in women with positive C-UBT or tTG titre or hypergastrinaemia.
Heavy menstrual loss was present in 50.8%. Non-invasive tests were positive in 40/59 (67.8%): 30 had positive C-UBT, 12 had hypergastrinaemia, 7 had positive tTG and 3 had positive FOB. Women tested positive were similar to those tested negative as far as concerned age, haemoglobin and ferritin levels and heavy menstrual flow (55% versus 42.1%). All 40 women tested positive underwent gastroscopy with biopsies. Four (10%) had bleeding-associated lesions and 34 (85%) had non-bleeding-associated lesions. As regards upper GI findings, no differences were observed between women with normal and those with heavy menstrual flow. No lower GI tract lesions were detected in the three women with positive FOB.
Our data suggest that premenopausal women with iron-deficiency anaemia benefit from endoscopic evaluation of the upper GI tract irrespective of menstrual flow.
在绝经前女性中，缺铁性贫血很常见，月经失血常被认为是病因，但尚不清楚这些女性是否应接受胃肠道（GI）评估。我们旨在前瞻性研究绝经前缺铁性贫血女性无论月经失血情况如何是否能从GI评估中获益。
研究人群包括59例连续的绝经前缺铁性贫血女性。排除有明显或疑似贫血病因的女性以及年龄≤21岁的女性。月经量过多不作为排除标准。所有受试者均进行了全血细胞计数、铁蛋白检测、粪便潜血（FOB）非侵入性检测、碳-尿素呼气试验（C-UBT）、抗组织转谷氨酰胺酶抗体（tTG）检测和胃泌素水平检测。C-UBT或tTG滴度阳性或高胃泌素血症的女性进行了胃镜检查，取胃窦部（n = 3）、胃体部（n = 3）和十二指肠部（n = 2）活检。
50.8%的女性月经量过多。40/59（67.8%）的非侵入性检测呈阳性：30例C-UBT阳性，12例高胃泌素血症，7例tTG阳性，3例FOB阳性。检测呈阳性的女性在年龄、血红蛋白和铁蛋白水平以及月经量过多方面与检测呈阴性的女性相似（55%对42.1%）。所有40例检测呈阳性的女性均接受了胃镜活检。4例（10%）有出血相关病变，34例（85%）有非出血相关病变。关于上消化道检查结果，月经量正常和月经量过多的女性之间未观察到差异。3例FOB阳性的女性未检测到下消化道病变。
我们的数据表明，绝经前缺铁性贫血女性无论月经失血情况如何，均可从上消化道内镜评估中获益。
