Evaluation of Iron Deficiency Anemia in Older Adults

Abstract

Anemia although a frequent problem in all age groups, is an important cause of morbidity and mortality in the elderly. Despite standard endoscopic diagnostic evaluations with esophagogastroduodenoscopy (EGD) and colonoscopy, up to 30% of patients with iron deficiency anemia (IDA) are without a definitive diagnosis. Obscure gastrointestinal bleeding (OGIB) (occult or overt) from the small bowel, could be the source of IDA in patients with normal EGD and colonoscopy. Wireless capsule endoscopy (WCE), a relatively new diagnostic modality helps in the detection of small bowel mucosal abnormalities. The aim of this study is to report on the diagnostic yield (DY) of WCE for IDA with or without OGIB in older adults and its comparison with younger age groups. In this retrospective study, data is based on652 consecutive WCE performed during a 5-year period (2002 to 2007). Total number ofWCE=652 (males=311, females=341). IDA was the indication for WCE in 424 of 652 cases (65%). Most common finding observed by WCE in patients with IDA without OGIB: group 1 (age<50 y)=small bowel erosion (19%) and ulceration (19%), group 2 (age 50 to 64 y)=small bowel erosion (33%), group 3 (age 65 to 85 y, older adults)=small bowel erosion (30%), and group 4 (age>85 y, the oldest old)=small bowel erosion (38%). Most common finding observed by WCE in patients with IDA with OGIB: group 1=small bowel ulceration (19%), group 2=small bowel erosion (26%), group 3=small bowel erosion (38%), and group 4=angiodysplasia (55%). DY of WCE for IDA without OGIB: group 1=50%, group 2=52%, group 3=56%, and group 4=69%. DY of WCE for IDA with OGIB: group 1=38%, group 2=58%, group 3=63%, and group 4=73%. Active bleeding in the small bowel was seen in 48 of 424 (11%) patients with IDA. WCE, a valuable tool for the visualization of entire small bowel mucosa plays a critical role for the evaluation of IDA in patients with negative EGD and colonoscopy. Small bowel erosions, ulcerations, and angiodysplasia observed by WCE are the most frequent findings in patients with IDA. DY of WCE in the evaluation of IDA progressively increases as age advances.