Tahaseen Shaik Mohammad, Kirti Ravi, Kumar Ramesh, Pandey Sanjay, Rao Rajath, Kumar Anjani, Arya Rahul, Maji Tanmoy, Biswas Ratnadeep
Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India.
Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India.
J Family Med Prim Care. 2024 Nov;13(11):5341-5348. doi: 10.4103/jfmpc.jfmpc_1150_24. Epub 2024 Nov 18.
About a third of the world's population is estimated to suffer from anaemia, and iron deficiency is expected to account for about half of all anaemia cases. This study was designed to get an estimate of the proportion of patients with iron deficiency anaemia (IDA) who have a significant gastrointestinal (GI) pathology, in particular a GI malignancy, and to identify any risk factors or predictors for the same.
This cross-sectional study was conducted at a hospital in Eastern India. The study population comprised males above the age of 18 and postmenopausal females with IDA, excluding those haemodynamically unstable or with chronic diseases. Data collection included a detailed history, sociodemographic details, dietary habits, GI symptoms, and severity of anaemia. Faecal occult blood tests (OBTs) were conducted, and patients were referred for upper and lower GI endoscopy with biopsies.
Out of the 257 patients, 50.97% (n = 131) had a significant GI pathology, and 25.68% (n = 66) had a GI malignancy. Male gender (AOR: 5.203, 95% CI: 1.725-15.698) and a positive stool OBT (AOR: 6.516, 95% CI: 2.255-18.828) were found to be independent risk factors for any GI pathology. Age 40 years or above (AOR: 11.376, 95% CI: 1.199-107.946), loss of appetite (AOR: 15.548, 95% CI: 1.416-170.735), pain abdomen (AOR: 5.566, 95% CI: 1.149-26.953), dysphagia (AOR: 7.945, 95% CI: 1.036-60.915), family history of malignancy (AOR: 46.726, 95% CI: 4.076-535.645), and positive OBT (AOR: 22.430, 95% CI: 3.933-127.915) were found to be independent risk factors of GI malignancy.
This study shows that a large proportion of adult males and postmenopausal females presenting with IDA in India have significant GI pathology. Furthermore, a significant proportion of them have GI malignancies. Thus, bidirectional endoscopy should be considered for these patients. Male patients, age >40, those with history of loss of appetite or weight, pain abdomen or dysphagia, positive family history, and positive OBT should be prioritised for the investigation.
据估计，全球约三分之一的人口患有贫血症，缺铁预计占所有贫血病例的一半左右。本研究旨在估计缺铁性贫血（IDA）患者中存在重大胃肠道（GI）病变，特别是胃肠道恶性肿瘤的比例，并确定其相关的危险因素或预测因素。
这项横断面研究在印度东部的一家医院进行。研究对象包括18岁以上的男性和患有IDA的绝经后女性，排除那些血流动力学不稳定或患有慢性疾病的患者。数据收集包括详细病史、社会人口统计学细节、饮食习惯、胃肠道症状和贫血严重程度。进行了粪便潜血试验（OBT），并将患者转诊进行上下消化道内镜检查及活检。
在257例患者中，50.97%（n = 131）有重大胃肠道病变，25.68%（n = 66）有胃肠道恶性肿瘤。男性（调整后比值比[AOR]：5.203，95%置信区间[CI]：1.725 - 15.698）和粪便OBT阳性（AOR：6.516，95% CI：2.255 - 18.828）被发现是任何胃肠道病变的独立危险因素。40岁及以上（AOR：11.376，95% CI：1.199 - 107.946）、食欲不振（AOR：15.548，95% CI：1.416 - 170.735）、腹痛（AOR：5.566，95% CI：1.149 - 26.953）、吞咽困难（AOR：7.945，95% CI：1.036 - 60.915）、恶性肿瘤家族史（AOR：46.726，95% CI：4.076 - 535.645）和OBT阳性（AOR：22.430，95% CI：3.933 - 127.915）被发现是胃肠道恶性肿瘤的独立危险因素。
本研究表明，在印度，大量患有IDA的成年男性和绝经后女性存在重大胃肠道病变。此外，其中相当一部分人患有胃肠道恶性肿瘤。因此，对于这些患者应考虑进行双向内镜检查。男性患者、年龄>40岁、有食欲不振或体重减轻史、腹痛或吞咽困难史、家族史阳性和OBT阳性的患者应优先进行检查。
