Re: Ko et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

Abstract

We read the clinical practice guideline “AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia” with both interest and concern.1,2 Interest because for reproductive aged women, iron deficiency (ID) and ID anemia (IDA) are highly prevalent and symptomatic disorders both domestically and worldwide, and concern because of, and despite the “lack of direct data…in premenopausal women,” bidirectional endoscopy is recommended for all. These recommendations are in stark contrast with those of the British Society of Gastroenterology published in 2011 and aimed at the developed world that state: “menstrual blood loss is the most common cause of IDA in premenopausal women,” and, consequently, that “All premenopausal women with IDA should be screened for coeliac disease, but other upper and lower GI investigation should be reserved for those aged 50 years or older.”3 We see no new evidence justifying the position stated by the American Gastroenterological Association (AGA).