Department of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
Department of Gastroenterology and Hepatology, VA NY Harbor Healthcare System, 800 Poly Place, Brooklyn, NY, 11209, USA.
BMC Gastroenterol. 2024 Aug 19;24(1):269. doi: 10.1186/s12876-024-03372-y.
While bidirectional endoscopy is recognized as the standard approach for investigating iron deficiency anemia (IDA) in men older than 45 and postmenopausal women, evidence supporting the application of this approach in younger men and premenopausal women is scarce in the absence of symptoms. Our primary aim is to identify the diagnostic yield of bidirectional endoscopy in men younger than 45 and premenopausal women, and describe the clinical characteristics of those with significant endoscopic and pathology-proven findings.
We performed a retrospective chart review including patients younger than age 45 with IDA who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy at the Brooklyn VA Hospital between 2009 and 2023. Demographic, clinical, and endoscopic patient data was all collected, stratified, analyzed, and interpreted.
In 143 patients younger than age 45 with IDA, 28.6% were found to have positive upper gastrointestinal (GI) findings, of which 70.3% were pathology-proven H. pylori cases. 57.9% of patients reported upper GI symptoms, while 42.9% of patients were asymptomatic. In total, 18.2% of symptomatic patients were found to have clinically significant findings on EGD as compared with 42.9% of asymptomatic patients. Additionally, 9.1% of symptomatic patients were found to have biopsy proven H. pylori-associated gastritis or duodenitis as compared with 33.9% of asymptomatic patients. Of the patients who underwent colonoscopy, 8.3% were found to have lower GI lesions.
We found the diagnostic yield of EGD to be significantly higher than that of colonoscopy in younger IDA patients. Our findings suggest current guidelines are clinically relevant to the young patient cohort. Our study also found asymptomatic IDA patients below age 45 to have a significantly higher diagnostic yield of EGD as compared to symptomatic IDA patients within the same age cohort. The differences in diagnostic yields may be a result of symptomatic patients being more likely to have been prescribed proton pump inhibitors or histamine receptor antagonists prior to endoscopy.
虽然双向内镜检查被认为是诊断 45 岁以上男性和绝经后女性缺铁性贫血（IDA）的标准方法，但在没有症状的情况下，缺乏支持在年轻男性和绝经前女性中应用这种方法的证据。我们的主要目的是确定双向内镜检查在 45 岁以下男性和绝经前女性中的诊断效果，并描述那些内镜和病理检查有显著发现的患者的临床特征。
我们进行了一项回顾性病历审查，纳入了 2009 年至 2023 年间在布鲁克林退伍军人事务医院接受食管胃十二指肠镜检查（EGD）和/或结肠镜检查的年龄小于 45 岁且 IDA 的患者。收集、分层、分析和解释了人口统计学、临床和内镜患者数据。
在 143 名年龄小于 45 岁且 IDA 的患者中，28.6%的患者有阳性上消化道（GI）发现，其中 70.3%为经病理证实的 H. pylori 病例。57.9%的患者报告有上 GI 症状，而 42.9%的患者无症状。总的来说，与无症状患者相比，有症状患者中发现有临床意义的 EGD 发现的比例为 18.2%，而无症状患者为 42.9%。此外，与无症状患者相比，有症状患者中活检证实的 H. pylori 相关胃炎或十二指肠炎的比例为 9.1%，无症状患者为 33.9%。在接受结肠镜检查的患者中，8.3%的患者有下 GI 病变。
我们发现 EGD 的诊断效果明显高于年轻 IDA 患者的结肠镜检查。我们的发现表明，目前的指南与年轻患者群体具有临床相关性。我们的研究还发现，与同年龄组的有症状 IDA 患者相比，年龄小于 45 岁且无症状的 IDA 患者的 EGD 诊断效果明显更高。诊断效果的差异可能是由于症状患者在接受内镜检查前更有可能被开质子泵抑制剂或组胺受体拮抗剂。
