Moses P L, Smith R E
Section of Gastroenterology, University of Vermont College of Medicine, Burlington, USA.
Postgrad Med. 1995 Aug;98(2):213-6, 219, 222-4 passim.
Gastrointestinal blood loss is the primary cause of iron deficiency anemia in older adults. Bidirectional endoscopy (combined colonoscopy and esophagogastroduodenoscopy) is highly sensitive and specific in its ability to locate gastro-intestinal lesions resulting in iron deficiency anemia. Although the diagnostic yield of esophagogastroduodenoscopy is higher than that of colonoscopy, the possibility of malignant disease dictates that initial colonoscopy be performed in all but a few cases involving distinct upper gastrointestinal risk factors and symptoms. If neither colonoscopy nor esophagogastroduodenoscopy identifies a source of blood loss, a safe course is to observe the patient and provide supplemental iron. Patients who fail to respond to supplemental iron or who become transfusion-dependent require further evaluation. Small-bowel evaluation has a role in selected patients.
胃肠道失血是老年人缺铁性贫血的主要原因。双向内镜检查（联合结肠镜检查和食管胃十二指肠镜检查）在定位导致缺铁性贫血的胃肠道病变方面具有高度的敏感性和特异性。虽然食管胃十二指肠镜检查的诊断率高于结肠镜检查，但恶性疾病的可能性决定了除少数涉及明确上消化道危险因素和症状的病例外，所有患者均应首先进行结肠镜检查。如果结肠镜检查和食管胃十二指肠镜检查均未发现失血来源，安全的做法是观察患者并补充铁剂。对补充铁剂无反应或出现输血依赖的患者需要进一步评估。小肠评估在部分患者中具有一定作用。
