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Diagnostic findings and long-term prognosis in children with anemia undergoing GI endoscopies
Marleena Repo1, Teemu Rajalahti2, Pauliina Hiltunen2
1Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland.
Insights
Anemia in children undergoing endoscopy significantly increases the likelihood of a diagnosis, particularly for conditions like celiac and inflammatory bowel disease. However, endoscopies are less beneficial for anemic children without other symptoms or lab abnormalities.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Diagnostic Endoscopy
Background:
- Intestinal diseases are a common cause of anemia in children.
- The diagnostic yield of endoscopic investigations for children with anemia is not well-established.
Purpose of the Study:
- To investigate the diagnostic outcomes of endoscopic procedures in children with anemia.
- To compare diagnostic findings between anemic and nonanemic pediatric patients.
Main Methods:
- Retrospective analysis of consecutive gastrointestinal (GI) endoscopies in children.
- Comparison of clinical presentation and diagnostic outcomes between anemic and nonanemic groups.
- Identification of predictors for diagnosis in anemic children.
Main Results:
- Children with anemia were more likely to receive a diagnosis (72.9% vs 39.3%), especially celiac disease and inflammatory bowel disease.
- Predictors for diagnosis in anemic children included age, GI symptoms, poor growth, and specific lab markers.
- Endoscopies in anemic children without additional symptoms or lab abnormalities yielded few diagnoses.
Conclusions:
- Anemia is an important alarm symptom that increases the probability of a diagnosis via endoscopy.
- Endoscopic investigation is valuable for anemic children, but less so when other clinical or laboratory abnormalities are absent.
Background And Aims:
Intestinal diseases are regarded as a common cause of anemia, but the diagnostic outcomes of children with anemia undergoing endoscopic investigations are unclear. We investigated this issue in a large cohort of children.
Methods:
Indications for and findings of consecutive gastrointestinal (GI) endoscopies were collected. Clinical presentation and diagnostic outcomes were compared between anemic and nonanemic patients and between anemic patients with and without a diagnosis. Diagnoses received during follow-up were collected.
Results:
Of 2395 consecutive endoscopies, 251 children with and 613 children without anemia had undergone either diagnostic esophagogastroduodenoscopy (EGD) (51.4% and 51.4%, respectively), colonoscopy (4.0% and 11.4%), or both (45.8% and 37.8%). Children with anemia more often received diagnoses (72.9% vs 39.3%; odds ratio [OR], 4.18; 95% confidence interval [CI], 3.03-5.77), particularly of celiac disease (26.3% vs 15.5%, P < .001) and of inflammatory bowel disease (31.1% vs 9.1%, P < .001), than did nonanemic children. The diagnosis in anemic patients was predicted by age 5 to 12 years (OR, 3.52; 95% CI, 1.27-9.75), presence of diarrhea (OR, 2.04; 95% CI, 1.07-3.90), melena/hematochezia (OR, 2.40; 95% CI, 1.17-4.92), poor growth (OR, 3.94; 95% CI, 1.70-9.15), positive celiac serology (OR, 11.81; 95% CI, 3.47-40.12), high calprotectin (OR, 12.86; 95% CI, 4.00-41.32), hypersedimentation (OR, 2.65; 95% CI, 1.29-5.44), and hypoalbuminemia (OR, 5.05; 95% CI, 1.56-16.34). Thirty children with anemia (12.0%) had no GI symptoms, and 22 of them (73.3%) were given diagnoses at the time of the endoscopies. All 22 had additional laboratory abnormalities, whereas these were present in only 2 of 8 undiagnosed children. None of them was diagnosed later in the follow-up of up to 11 years, in contrast to 4 (6.7%) of all anemic and 33 (8.9%) of all nonanemic patients.
Conclusions:
Anemia increased the probability of being given a diagnosis, emphasizing its importance as an alarm symptom. However, endoscopies in anemic patients without additional symptoms or laboratory abnormalities seldom improved the diagnostic yield.
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