Diagnostic Yield of Gastrointestinal Endoscopy in Patients with Iron Deficiency Anemia

Iron deficiency anemia (IDA) is the most common cause of anemia and represents a significant global health problem. While the role of endoscopy in diagnosing IDA is well-established, the frequency and types of lesions identified vary widely across different regions. Factors such as symptomatology, complications, age, and geographic location significantly influence diagnostic outcomes. This study was conducted to evaluate the diagnostic yield of various endoscopic techniques in patients with IDA in an Indian cohort.

This retrospective analysis included all patients evaluated for IDA in the Department of Gastroenterology and Hepatology from January 2016 to March 2023. Data collection included patient demographics, clinically significant endoscopic findings, and laboratory parameters such as hemoglobin levels, serum ferritin, total iron-binding capacity, and serum iron concentrations.

A total of 554 patients were initially enrolled, of whom 435 underwent upper gastrointestinal (GI) endoscopy, and 309 underwent colonoscopy after applying exclusion criteria. The diagnostic yield for detecting clinically significant lesions via upper endoscopy was 43.6%, while colonoscopy demonstrated a yield of 52.4%. Dual lesions were identified in 2.4% of all patients. The most common finding on upper endoscopy was peptic ulcer disease (13.3%), followed by esophageal varices (8.3%). On colonoscopy, colonic ulcers were the most prevalent finding (25.24%), followed by colonic malignancies (12%). Symptom presence was significantly associated with higher endoscopic diagnostic yield (p < 0.05).

GI endoscopy should be considered an essential diagnostic tool for all patients with IDA. The selection of the initial endoscopic modality should be guided by the presence of symptoms. Given the favorable risk-benefit ratio, GI evaluation is recommended across all age groups, including premenopausal women.