Kepczyk T, Cremins J E, Long B D, Bachinski M B, Smith L R, McNally P R
Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colorado, USA.
Am J Gastroenterol. 1999 Jan;94(1):109-15. doi: 10.1111/j.1572-0241.1999.00780.x.
The cause of iron deficiency anemia (IDA) in premenopausal women is often presumed to be menstrual blood loss. The purpose of this study was to determine the diagnostic value of a comprehensive gynecological and gastrointestinal evaluation in premenopausal women with IDA.
Nineteen premenopausal, nonpregnant women older than 18 yr of age with IDA defined by a hemoglobin < 12 gm/dl with serum ferritin < 10 ng/ml participated in the study. Evaluations included directed history and physical examination by a specialist in gynecology and a subspecialist in gastroenterology, esophagogastroduodenoscopy, colonoscopy, upper gastrointestinal radiography with small bowel follow-through, antiendomysial antibody, and fecal occult blood tests.
Seven of 19 (37%) premenopausal women with IDA were diagnosed to have a gynecological cause of anemia by a specialist in that field. Although only four of these seven patients had digestive complaints, all but one (86%) were discovered to have gastrointestinal disease by upper endoscopy; findings were duodenal ulcer and Helicobacter pylori (H. pylori) gastritis (one), esophagitis and H. pylori gastritis (one), erosive esophagitis (one), gastric arteriovenous malformations (one), and nodular/erosive H. pylori gastritis (two). Fecal occult blood testing was positive in only two (29%) subjects; upper endoscopy revealed erosive esophagitis and gastric arteriovenous malformations. Twelve of the 19 (63%) premenopausal women with IDA were not diagnosed to have a gynecological source of anemia by a specialist in that field. Fecal occult blood testing was negative among all women tested and the only digestive complaint was heartburn (pyrosis) in seven. Each was identified to have esophagitis, duodenal ulcer, or gastritis by upper endoscopy. Colonoscopic examination of the 12 subjects without gynecologic etiology for IDA revealed pan colitis (one), diverticulosis (one), diverticulosis and melanosis coli (one), hyperplastic polyps (one), and nodular lymphoid aggregates (one).
Significant upper gastrointestinal disease is identifiable among most premenopausal women with IDA (18 of 19 or 95%), even when careful evaluation by a specialist in gynecology suggests a gynecological source. Upper endoscopy should be considered in the evaluation of all premenopausal women with IDA expressing digestive complaints or in those with IDA refractory to iron supplementation. Lower endoscopic examination may be reserved for those women with symptoms or signs suggestive of colorectal disorders.
绝经前女性缺铁性贫血（IDA）的病因通常被认为是月经失血。本研究的目的是确定全面的妇科和胃肠道评估对绝经前IDA女性的诊断价值。
19名年龄超过18岁的绝经前非妊娠女性参与了本研究，她们被诊断为IDA，血红蛋白<12g/dl，血清铁蛋白<10ng/ml。评估包括由妇科专家和胃肠病学亚专科医生进行的针对性病史询问和体格检查、食管胃十二指肠镜检查、结肠镜检查、上消化道造影及小肠造影、抗肌内膜抗体检测和粪便潜血试验。
19名绝经前IDA女性中有7名（37%）被该领域专家诊断为贫血有妇科原因。虽然这7名患者中只有4名有消化系统症状，但除1名外（86%），其余通过上消化道内镜检查均发现有胃肠道疾病；检查结果为十二指肠溃疡和幽门螺杆菌（H. pylori）胃炎（1例）、食管炎和H. pylori胃炎（1例）、糜烂性食管炎（1例）、胃动静脉畸形（1例）以及结节性/糜烂性H. pylori胃炎（2例）。仅2名（29%）受试者粪便潜血试验呈阳性；上消化道内镜检查发现糜烂性食管炎和胃动静脉畸形。19名绝经前IDA女性中有12名（63%）未被该领域专家诊断为贫血有妇科原因。所有接受检测的女性粪便潜血试验均为阴性，唯一的消化系统症状是7名女性有烧心（胃灼热）。通过上消化道内镜检查，她们均被诊断为食管炎、十二指肠溃疡或胃炎。对12名无妇科病因的IDA女性进行结肠镜检查，结果显示全结肠炎（1例）、憩室病（1例）、憩室病和结肠黑变病（1例）、增生性息肉（1例）以及结节性淋巴样聚集（1例）。
大多数绝经前IDA女性（19例中的18例或95%）即使经妇科专家仔细评估提示有妇科病因，仍可发现有明显的上消化道疾病。对于所有有消化系统症状的绝经前IDA女性或对铁剂补充治疗无效的IDA女性，评估时应考虑进行上消化道内镜检查。对于有提示结直肠疾病症状或体征的女性，可考虑进行下消化道内镜检查。
