Rodrigues Jaime Pereira, Pinho Rolando, Silva Joana, Ponte Ana, Sousa Mafalda, Silva João Carlos, Carvalho João
Jaime Pereira Rodrigues, Rolando Pinho, Joana Silva, Ana Ponte, Mafalda Sousa, João Carlos Silva, João Carvalho, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, Porto 4434-502, Portugal.
World J Gastroenterol. 2017 Jun 28;23(24):4444-4453. doi: 10.3748/wjg.v23.i24.4444.
To evaluate the adequacy of the study of iron deficiency anemia (IDA) in real life practice prior to referral to a gastroenterology department for small bowel evaluation.
All consecutive patients referred to a gastroenterology department for small bowel investigation due to iron deficiency anemia, between January 2013 and December 2015 were included. Both patients referred from general practitioners or directly from different hospital departments were selected. Relevant clinical information regarding prior anemia workup was retrospectively collected from medical records. An appropriate pre-referral study was considered the execution of esophagogastroduodenoscopy (EGD) with () investigation, colonoscopy with quality standards (recent, total and with adequate preparation) and celiac disease (CD) screening (through serologic testing and/or histopathological investigation).
A total of 77 patients (58.4% female, mean age 67.1 ± 16.7 years) were included. Most (53.2%) patients were referred from general practitioners, 41.6% from other hospital specialties and 5.2% directly from the emergency department. The mean pre-referral hemoglobin concentration was 8.8 ± 2.0 g/dL and the majority of anemias had microcytic (71.4%) and hypochromic (72.7%) characteristics. 77.9% of patients presented with an incomplete pre-referral study: EGD in 97.4%, with investigation in 58.3%, colonoscopy with quality criteria in 63.6%, and CD screening in 24.7%. Patients with an appropriate study at the time of referral were younger (48.7 ± 17.7 72.3 ± 12.3 years, < 0.001). Small bowel evaluation was ultimately undertaken in 72.7% of patients, with a more frequent evaluation in patients with a quality colonoscopy at referral (78.6% 23.8%); < 0.001 (OR = 11.7, 95%CI: 3.6-38.6). The most common diagnosis regarded as the likely cause of IDA was small bowel angioectasia (18.2%) but additional causes were also found in the upper and lower gastrointestinal tracts of near 20% of patients. Small bowel studies detected previously unknown non-small bowel findings in 7.7% of patients.
The study of anemia prior to referral to gastroenterology department is unsatisfactory. Only approximately a quarter of patients presented with an appropriate study.
评估在转诊至胃肠病科进行小肠评估之前，缺铁性贫血（IDA）在实际临床实践中的研究充分性。
纳入2013年1月至2015年12月期间因缺铁性贫血转诊至胃肠病科进行小肠检查的所有连续患者。入选患者包括由全科医生转诊或直接从不同医院科室转诊而来的患者。从病历中回顾性收集有关先前贫血检查的相关临床信息。适当的转诊前研究被认为是进行食管胃十二指肠镜检查（EGD）及（）检查、符合质量标准（近期、全面且准备充分）的结肠镜检查以及乳糜泻（CD）筛查（通过血清学检测和/或组织病理学检查）。
共纳入77例患者（女性占58.4%，平均年龄67.1±16.7岁）。大多数患者（53.2%）由全科医生转诊，41.6%来自其他医院专科，5.2%直接来自急诊科。转诊前平均血红蛋白浓度为8.8±2.0 g/dL，大多数贫血具有小细胞性（71.4%）和低色素性（72.7%）特征。77.9%的患者转诊前研究不完整：EGD检查不完整的占97.4%，（）检查不完整的占58.3%，符合质量标准的结肠镜检查不完整的占63.6%，CD筛查不完整的占24.7%。转诊时进行了适当研究的患者更年轻（48.7±17.7岁对72.3±12.3岁，P<0.001）。最终72.7%的患者进行了小肠评估，转诊时进行了高质量结肠镜检查的患者评估更为频繁（78.6%对23.8%）；P<0.001（OR=11.7，95%CI：3.6 - 38.6）。被认为是IDA可能病因的最常见诊断是小肠血管扩张（18.2%），但在近20%的患者的上、下胃肠道中也发现了其他病因。小肠检查在7.7%的患者中发现了先前未知的非小肠病变。
转诊至胃肠病科之前对贫血的研究并不理想。只有约四分之一的患者进行了适当的研究。
