Rockey D C, Cello J P
Gastroenterology Division, San Francisco General Hospital, University of California.
N Engl J Med. 1993 Dec 2;329(23):1691-5. doi: 10.1056/NEJM199312023292303.
Idiopathic iron-deficiency anemia in adults is assumed to be the result of occult chronic blood loss from the gastrointestinal tract. The aim of this study was to determine an effective clinical strategy for managing this common clinical problem.
We prospectively studied 100 consecutive patients with iron-deficiency anemia, using colonoscopy and esophagogastroduodenoscopy and, in patients with negative endoscopic studies, enteroclysis (radio-graphic examination of the small intestine).
Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 62 of the 100 patients. Endoscopic examination of the upper gastrointestinal tract showed a bleeding source in 36 patients, and colonoscopy showed a lesion in 25; 1 patient had lesions in both the upper and lower gastrointestinal tracts. The most common abnormality in the upper gastrointestinal tract was peptic ulceration (duodenal ulcer in 11 patients, gastric ulcer in 5, and anastomotic ulcer in 3). Cancers, detected in 11 patients, were the most common colonic lesions. Enteroclysis was performed in 26 of the 38 patients with negative endoscopic studies, and the results were normal in all instances. Symptoms at a specific site in the gastrointestinal tract were predictive of disease in the corresponding portion of the bowel. In addition, the combination of positive tests for fecal occult blood and symptoms in the lower gastrointestinal tract had a positive predictive value of 86 percent for detecting a lesion in the lower gastrointestinal tract.
Gastrointestinal lesions (in both the upper gastrointestinal tract and the colon) are frequently found in patients with iron-deficiency anemia. Since site-specific symptoms are predictive of abnormalities in the corresponding portion of the bowel, the initial evaluation should be directed by the location of the symptoms. Concomitant lesions of the upper and lower gastrointestinal tract are rare; thus, detection of a likely source of blood loss during the initial examination may obviate the need for further procedures.
成人特发性缺铁性贫血被认为是胃肠道隐匿性慢性失血的结果。本研究的目的是确定一种有效的临床策略来处理这一常见的临床问题。
我们对100例连续的缺铁性贫血患者进行了前瞻性研究，采用结肠镜检查和食管胃十二指肠镜检查，对于内镜检查阴性的患者，采用小肠灌肠造影（小肠的X线检查）。
胃肠内镜检查显示，100例患者中有62例存在至少一处可能导致失血的病变。上消化道内镜检查发现36例有出血源，结肠镜检查发现25例有病变；1例患者上、下消化道均有病变。上消化道最常见的异常是消化性溃疡（十二指肠溃疡11例，胃溃疡5例，吻合口溃疡3例）。11例患者检测出癌症，是最常见的结肠病变。38例内镜检查阴性的患者中有26例进行了小肠灌肠造影，结果均正常。胃肠道特定部位的症状可预测相应肠段的疾病。此外，粪便潜血试验阳性与下消化道症状相结合，对检测下消化道病变的阳性预测值为86%。
缺铁性贫血患者常发现胃肠道病变（上消化道和结肠）。由于特定部位的症状可预测相应肠段的异常，初始评估应以症状部位为导向。上、下消化道同时存在病变的情况很少见；因此，在初始检查中发现可能的失血来源可能无需进一步检查。
