Ackerman Z, Eliakim R, Stalnikowicz R, Rachmilewitz D
Department of Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
Am J Gastroenterol. 1996 Oct;91(10):2099-102.
The recommended evaluation of adult patients presenting with iron deficiency anemia (IDA) includes the performance of colonoscopy and esophagogastroduodenoscopy. IDA is a common feature in patients with celiac disease and, in several, may be the only presenting sign. The performance of small bowel biopsy (SBB) for the evaluation of celiac disease as the cause of IDA is not routinely recommended. The aim of the present study was to determine the yield of SBB performed during routine endoscopy of adults with IDA.
We prospectively studied 93 patients with IDA. Three control groups were included: 23 patients with steatorrhea, 37 patients with idiopathic diarrhea, and 9 patients in whom SBB was performed for miscellaneous indications.
Eleven patients with IDA and two patients with steatorrhea had SBB findings compatible with celiac disease. None of the patients from the other two groups had similar findings. Two patients with IDA, who were later diagnosed to suffer from celiac disease, presented: one with occult blood in the stool and the other with rectal bleeding. Subgroup analysis of patients with IDA revealed that patients with celiac disease were younger, had significantly more episodes of diarrhea, lower mean hemoglobin level, and longer duration of anemia than those without celiac disease. Other mucosal abnormalities were found in a substantial number of patients with celiac disease: esophagitis, gastritis, duodenitis, hemorrhoids, and colitis.
A substantial number of adult Israeli patients who present with IDA are found, on SBB, to have mucosal abnormalities compatible with the diagnosis of celiac disease. The presence of esophagitis, gastritis, or duodenitis on esophagogastroduodenoscopy, or other abnormalities on colonoscopy, do not exclude the coexistence of celiac disease. Celiac disease should be included and routinely looked for in the differential diagnosis of adult patients with IDA.
对于出现缺铁性贫血（IDA）的成年患者，推荐的评估方法包括进行结肠镜检查和食管胃十二指肠镜检查。IDA是乳糜泻患者的常见特征，在一些患者中可能是唯一的表现症状。对于将小肠活检（SBB）作为评估IDA病因的乳糜泻检查方法，目前并不常规推荐。本研究的目的是确定在成年IDA患者的常规内镜检查中进行SBB的诊断率。
我们对93例IDA患者进行了前瞻性研究。纳入了三个对照组：23例脂肪泻患者、37例特发性腹泻患者以及9例因其他适应症进行SBB的患者。
11例IDA患者和2例脂肪泻患者的SBB结果符合乳糜泻诊断。其他两组患者均未出现类似结果。2例IDA患者后来被诊断患有乳糜泻，其中1例表现为大便潜血，另1例表现为直肠出血。对IDA患者的亚组分析显示，患有乳糜泻的患者比未患乳糜泻的患者更年轻，腹泻发作次数显著更多，平均血红蛋白水平更低，贫血持续时间更长。在大量乳糜泻患者中还发现了其他黏膜异常：食管炎、胃炎、十二指肠炎、痔疮和结肠炎。
大量出现IDA的成年以色列患者经SBB检查发现存在与乳糜泻诊断相符的黏膜异常。食管胃十二指肠镜检查发现食管炎、胃炎或十二指肠炎，或结肠镜检查发现其他异常，并不排除同时存在乳糜泻。在成年IDA患者的鉴别诊断中应纳入并常规排查乳糜泻。
