Stone Helen, Almilaji Orouba, John Christopher, Smith Carla, Surgenor Susan L, Ayres Lachlan, Williams Elizabeth J, Snook Jonathon
Gastroenterology Unit, Poole Hospital NHS Foundation Trust, Poole, UK.
Clinical Research Unit, Bournemouth University, Bournemouth, UK.
Frontline Gastroenterol. 2020 Sep 10;13(1):20-24. doi: 10.1136/flgastro-2020-101470. eCollection 2022.
To report our cumulative experience from a dedicated iron deficiency anaemia (IDA) clinic over the last 15 years-with particular emphasis on referral rate, uptake of investigation, impact on endoscopy services, diagnostic yield of gastrointestinal (GI) investigation and the issue of recurrent IDA.
A series of analyses of a register of 2808 referrals to the Poole IDA clinic between 2004 and 2018.
The study population of 2808 had a sex ratio of 1.9 (female/male ratio) and a median age of 72 years (IQR: 60-79). A rising referral rate over the study period appears to be plateauing at around 2 cases per 1000 population per annum. On the basis of a snapshot audit, investigation of IDA may now account for over 20% of all diagnostic endoscopies.Overall, 86% of cases underwent examination of the upper and lower GI tract. Significant GI pathology was identified in 27% of the investigated cohort. Adenocarcinoma of the upper or lower GI tract was found in 8.3%, the majority in the right colon. The prevalence of recurrent IDA was estimated at 12.4%, and the results of investigation of this subgroup are reported.
Unexplained IDA is common, particularly in those over 60 years, and may be the first indication of underlying GI malignancy in over 8% of cases. Unresolved challenges include accommodating the resulting endoscopy workload, establishing a risk/benefit ratio for investigating those with major comorbidities and the management of recurrent IDA.
报告我们在过去15年中一家专门的缺铁性贫血（IDA）诊所的累积经验，特别强调转诊率、检查接受情况、对内镜检查服务的影响、胃肠道（GI）检查的诊断率以及IDA复发问题。
对2004年至2018年间转诊至普尔IDA诊所的2808例病例登记册进行一系列分析。
2808例研究人群的性别比为1.9（女性/男性比），中位年龄为72岁（四分位间距：60 - 79岁）。研究期间转诊率呈上升趋势，目前似乎稳定在每年每1000人口约2例。根据一次抽样审计，IDA检查现在可能占所有诊断性内镜检查的20%以上。总体而言，86%的病例接受了上、下消化道检查。在27%的受调查队列中发现了显著的胃肠道病变。上消化道或下消化道腺癌的发现率为8.3%，大多数位于右半结肠。IDA复发的患病率估计为12.4%，并报告了该亚组的调查结果。
不明原因的IDA很常见，尤其是在60岁以上人群中，并且可能是超过8%病例中潜在胃肠道恶性肿瘤的首个迹象。尚未解决的挑战包括应对由此产生的内镜检查工作量、为患有严重合并症的患者确定检查的风险/效益比以及IDA复发的管理。
