2985 Low Diagnostic Yield of Routine Duodenal Biopsies in Asymptomatic Patients With Iron Deficiency Anemia

Abstract

INTRODUCTION: It is estimated that 1.6 billion people worldwide are anemic. Iron deficiency anemia (IDA) is the most common form of anemia worldwide. In adults without an obvious source of blood loss, the explanation for IDA is generally thought to be due to chronic gastrointestinal blood loss. Current guidelines recommend performing both upper and lower endoscopies for patients with iron deficiency anemia. Duodenal biopsies are routinely performed to evaluate for celiac sprue as the etiology of IDA. The primary aim of this study is to determine the diagnostic yield of routine duodenal biopsies performed for investigation of asymptomatic patients with iron deficiency anemia (without malabsorption symptoms). METHODS: A retrospective chart review was performed of patients undergoing esophagogastroduodenoscopy (EGD) with duodenal biopsy as work up of IDA. All duodenal biopsies were performed from January 2011 through April 2019 at an academic tertiary referral center. Inclusion criteria was ferritin ≤45 ng/mL within 1 year prior to EGD. If ferritin data was unavailable, physician records were reviewed for diagnosis of iron deficiency anemia in patients who had proven serum MCV < 80 um3 within 1 year prior to EGD. Data was collected for asymptomatic patients, N = 250. Charts were reviewed and patients with malabsorption symptoms such as abdominal pain, weight loss, diarrhea, and bloating were excluded. In addition, patients with rectal bleeding, history of IBD, gastrointestinal cancer, lymphoma or abdominal surgery leading to malabsorption were also excluded. A diagnosis of celiac disease was defined as a Marsh type 2 or greater on tissue biopsy. RESULTS: The median age of patients was 60.6 ± 14.1 of whom 43% were female. A total of 59% of cases were Caucasian, 19% were Hispanic, 8% African American, 8% Asian and 9% other. The mean of Hgb was 9.2 ± 1.9 gm/dL, MCV, 76.4 ± 8.0% and ferritin, 21.7 ± 38.7 um3. Of the sample, 25% had DM2, 20% had CAD, 14% had CKD, 12% had atrial fibrillation and 6% had cirrhosis. The overall diagnostic yield of the duodenal biopsies was 0.4% in asymptomatic patients. CONCLUSION: These results suggest that performing routine duodenal biopsies for celiac disease in patients with IDA is low yield in asymptomatic patients. Further studies are needed to characterize which patients with IDA would benefit from a duodenal biopsy for diagnosis of celiac disease.