Fatime DEMİR, Müjgan GÜRLER

Retrospective evaluation of endoscopies of male and postmenopausal female patients with iron deficiency

Iron deficiency anaemia (IDA) is the most common type of anaemia, and its frequency and causes vary according to patient populations. Considering IDA as being an important mortality and morbidity cause, understanding IDA influence on several pathologies is quite necessary. In our study, we investigated gastrointestinal (GIS) pathologies that may lead to IDA in male and postmenopausal female patients. In our study, the data of 234 patients who underwent endoscopy in our hospital due to IDA between 01.01.2016 - 31.12.2017 were analyzed retrospectively. Of the patients participating in the study, 126 were male and 108 were female, and the mean age of the patients was 64.17. Esophagogastroduodenoscopy (EGD) was performed in 86.7% of the patients, colonoscopy in 44.4%, and both in 31.2%. Lesion detection was 96% in EGD, 56% in colonoscopy, and 97.3% in patients with both. The most common lesions in patients who underwent EGD were non-erosive gastritis, erosive gastritis, and bulboduodenitis. After the biopsy was performed, Helicobacter pylori positivity was found in 35.4%, gastric atrophy in 13.3%, and Celiac disease in 1.4%. The most common lesions in patients who underwent colonoscopy were polyps, hemorrhoids and diverticulum. In general, it was seen that the polyps were less than 3 cm in number and less than 1 cm in size. The incidence of inflammatory bowel disease was 5.8%, and ulcerative colitis was more common. In the upper GIS scan, malignancy was 5.1% and gastric adenocarcinoma was 3.6%. The rate of colorectal malignancy, more frequently in the left colon, was determined as 2.9%. In our study, it was observed that IDA patients were frequently accompanied by lesions originating from the GIS system. Considering the variety and complications of lesions in patients with IDA, upper and lower GIS endoscopies should be performed together and without delay.

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1. Marton I, Agócs S, Babik B. Epidemiology of anemia. Orvosi Hetilap. 2020;161:1569-73.

2. Chaparro CM, Suchdev PS. Anaemia epidemiology, pathophysiology, and etiology in low-and middle-income countries. Ann NY Acad Sci. 2019;1450:15-31.

3. Lanier JB, Park JJ, Callahan RC. Anaemia in Older Adults. Am Fam Physician. 2018;98:437-42.

4. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131:505-14.

5. Gómez Ramírez S, Remacha Sevilla ÁF, Muñoz Gómez M. Anaemia in the elderly. Med Clin. 2017;149:496-503.

6. Halawi R, Moukhadder H, Taher A. Anemia in the elderly: a consequence of ageing? Expert Rev Hematol. 2017;10:327-35.

7. Nalbant S, Karan MA. Internal Medicine Specialist’s Guide to Approach to Anemia. J Internal Med. 2010;17:7-15.

8. Madej D, Borowska K, Bylinowska J, et al. Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate? Rocz Panstw Zakl Hig. 2013;64:97-104.

9. McIntyre AS, Long RG. Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut. 1993;34:1102-7.

10. Unal HU, Fidan C, Korkmaz M, et al. Gastrointestinal system endoscopy findings in patients with iron deficiency. Turkish J Academic Gastroenterol. 2012 1;11:113-6.

11. Karakus V, Giden A, Soysal Ersil D, et al. Etiology of Anemia, Risk Factors and Evaluation of Relapse in Adult Patients. Mugla Sıtkı Kocman University Medical J. 2016;3:1-6.

12. Cardenas VM, Mulla ZD, Ortiz M, et al. Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol. 2006;163:127-34.

13. Erdem ME, Kecici S, Akin S, et al. The relationship between iron deficiency anaemia and helicobacter pylori. Okmeydani J Med. 2014;30:82-5.

14. Kilicarslan H, Kalyon S, Yenice N. Etiopathogenesis of peptic ulcer. Okmeydani Medical J. 2011;27:65-9.

15. Dickey W, Kenny BD, McMillan SA, et al. Gastric as well as duodenal biopsies may be useful in the investigation of iron deficiency anaemia. Scand J Gastroenterol. 1997;32:469-72.

16. Cetinkaya ZA, Sezikli M, Guzelbulut F, et al. Results of gastrointestinal endoscopic examination in patients with iron deficiency anaemia. Dicle Medical J. 2011;38:155-9.

17. Okuturlar Y, Soylu A, Inan Y, et al. Lower and upper endoscopic examination results in patients with iron deficiency anaemia. Endosc Gastrointest. 2014;22:33-7.

18. Tamer A, Korkut E, Korkmaz U, Akcan Y. Our lower gastrointestinal endoscopy results: Duzce region. Medical J Kocatepe. 2005;6:29-31.

19. Bahcecioglu IH, Guzel Z, Celebi H, et al. Evaluation of the results of rectoscopy and colonoscopy performed in our clinic between 1990-1995. Gastroenterol. 1996;7:107-15.

20. Bach V, Schruckmayer G, Sam I, et al. Prevalence and possible causes of anaemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging. 2014;9:1187-96.

21. Balik AA, Celebi F, Atamanalp SS, et al. Our lower gastrointestinal system endoscopy results. Eurasian J Med. 2000;32:101-4.

22. Izbul T, Akalin M. The evaluation of diagnostic rectosigmoidoscopic examinations in Turkish Republic of Northern Cyprus. Turkish J Gastroenterol. 1999;10:268-71.

23. Suleymanlar I, Ertugrul C, Isitan F. Evaluation of diagnostic rectosigmoidoscopic examination. Turkish Gastroenterol. 1997;8:28.

24. Bayram M, Koksal AR, Boga S, et al. Evaluation of the result of gastroscopic and colonoscopic examinations done because of anaemia. Endosc Gastrointest. 2015 29;23:31-4.

25. Sharara AI, El-Halabi MM, Mansour NM, et al. Alcohol consumption is a risk factor for colonic diverticulosis. J Clin Gastroenterol. 2013;47:420-5. 26. Steel M. Colonic diverticular disease. Australian Fam Physician. 2004;33:983-6.

27. Katz PO, Salas L. Less frequent causes of upper gastrointestinal bleeding. Gastroenterol Clin North Am. 1993;22:875-89.

28. Capurso G, Baccini F, Osborn J, et al. Can patient characteristics predict the outcome of endoscopic evaluation of iron deficiency anaemia: a multiple logistic regression analysis. Gastrointest Endosc. 2004;59:766-71.

29. Kurtoglu E, Kayacetin E, Ugur A. Lower and upper gastrointestinal system findings in men and postmenopausal women with iron deficiency anaemia. Medical Network Clin Sci Doc. 2004;10:251-4.