Iron Deficiency Anemia: The Contribution of Upper Digestive Endoscopy in Etiological Investigation

Abstract

Iron-deficiency anemia is very common among patients in gastroenterology. The digestive system plays a key role in the pathophysiology of iron-deficiency. Indeed, digestive causes are one the most fequent etiology. This is why endoscopic evaluation is part of the etiological assessment of iron-deficiency anemia. The aim of this study is to investigate the usefulness of esophagogastroduodenoscopy (EGD) and histopathology in the etiological diagnosis of iron-deficiency anemias. Materials and Methods: This is a monocentric study conducted from January 2019 to December 2023. All patients with iron-deficiency anemia who underwent EGD were included. Various data were recorded, including patients' epidemiological information, laboratory findings, and results from endoscopic examinations. Results: Out of 2960 EGD, 576 (19,5%) were included in the study. The mean age of the patients was 49.81 years, ranging from 18 to 83 years. The male-to-female sex ratio was 0.67. It is notable that 47.5% of the patients had various medical histories: inflammatory bowel disease (IBD) in 19.13% of cases, history of non-steroidal anti-inflammatory drug (NSAID) use in 12.17%, coeliac disease in 6.13%, cirrhosis with portal hypertension in 8.70%. All patients underwent EGD. An abnormality was found in 63.4% of cases, including: Esophageal lesions: gastroesophageal varices in 13.3% of cases, erosive esophagitis in 7.5%, esophageal tumor in 0.6% of cases. Gastric lesions: erosive gastritis in 35% of cases, ulcerative gastritis in 22%, erythematous gastritis in 17%, gastric tumor in 15% of cases, supra-centimetric hyperplastic polyps in 5% of cases. Bulboduodenal lesions: erosive bulboduodenitis in 25% of cases, ulcerative bulboduodenitis in 18%, duodenal fold rarefaction in 16%, angiodysplasia in 3.5%. Gastric and duodenal biopsies were systematically performed. Duodenal biopsies showed a celiac disease aspect in 7.6% of cases, and nonspecific duodenitis in 4.6% of cases. Gastric biopsies revealed gastritis with Helicobacter pylori (Hp) in 57.6% of cases. Thus, the diagnostic yield of EGD was 47.33%. Conclusion: Iron deficiency anemia are common medical conditions in daily clinical practice. The multiple etiologies of iron deficiency anemia and the nonspecificity of symptoms make diagnosis difficult. Gastrointestinal lesions are frequently observed in patients with iron deficiency anemia. Digestive endoscopy has a great value in the etiological investigation of this pathology. Gastroscopy allows for the etiological diagnosis for many patients that’s why it is systematically recommended do it.