Results of gastrointestinal evaluation in 90 hospitalized iron deficiency anemia patients

Chronic occult blood loss from the gastrointestinal tract is widely accepted as a major cause of iron deficiency anemia.

To evaluate the diagnostic yield of gastroscopy, colonoscopy and fecal occult blood testing of hospitalized IDA patients, plus follow-up.

IDA was defined as hemoglobin < 12.5 g/dl (men) and 11 g/dl (women), and serum iron < 50 g/dl. The study group comprised 90 patients (42% male) with a mean age of 65 +/- 15 years and mean Hb 8.1 g/dl.

Gastroscopy and colonoscopy revealed a bleeding source in 28.8% and 14.4% respectively. Gastrointestinal symptoms were found in 23% of patients with diseases of the upper gastrointestinal tract and in 15.3% of the lower. The sensitivity of fecal occult blood tests in detecting lesions in the lower and upper GI tracts was 100% and 30.7% respectively. Forty-four patients (48.9%) were discharged from the hospital with IDA of unknown origin. Over the following year, 20 of the 44 patients required further hospitalization, and of these, 13 were found to have anemia. Of the remaining 24 patients who were not hospitalized again, 15 had anemia. Four patients (9%) had significant gastrointestinal lesions and two died during the follow-up.

Fecal occult blood is a sensitive examination for lower but not for upper GI tract lesions.