Unexplained Iron Deficiency Anemia Research Articles

Severe Unexplained Iron Deficiency Anemia in Children: High Yield of Upper Gastrointestinal Endoscopy Regardless of Gastrointestinal Symptoms.

In this retrospective study spanning 2016 to 2022, we aimed to evaluate the diagnostic utility of upper gastrointestinal endoscopy (UGE) in children under 18 years presenting with severe unexplained iron deficiency anemia (IDA), defined as microcytic anemia of hemoglobin ≤7g/dL with low ferritin levels. Of 106 children hospitalized for severe anemia, 29 had unexplained IDA (mean hemoglobin level of 6.2 [3.2 to 6.9] gr/dL), and 25 of them underwent UGE. The mean age was 10.7 ± 3.9 years, with 76% being female. Ten children (40%) had gastrointestinal (GI) symptoms at presentation. The cause of IDA was found in 18 (72%) of 25 children who underwent UGE, of whom 12 were without GI symptoms. Gastric nodularity, erosions, or polyps were observed in 68%, and gastritis was evident in 72% based on histopathology. Helicobacter pylori was found in 50% of those with gastritis. Follow-up showed normalized hemoglobin levels in 92% of cases, with only 2 children requiring repeat iron therapy. Our findings underscore the importance of incorporating UGE into the diagnostic investigation of severe unexplained IDA in children, irrespective of the presence of GI symptoms.

Endoscopy of the Gut: A Window into the Puzzle of Iron-deficiency Anemia

Abstract Background: Iron-deficiency anemia (IDA) is the most common form of anemia which affects almost every age group. It impacts with varied severity the quality of life of the person affected. IDA is caused by either decreased availability of food, especially during times of increased requirement or decreased absorption from the gastrointestinal (GI) tract or increased loss due to various reasons in different age groups. We tried to estimate the prevalence of GI causes in patients with IDA in a tertiary care hospital and describe the clinicopathological profile of the patients with IDA. Materials and Methods: A cross-sectional observational study was conducted in a tertiary care center in Western India on patients suffering from IDA. Male patients of >18 years and female patients >45 years with IDA and no known chronic disease or infection were included in the study and their endoscopic/colonoscopic findings were recorded and analyzed. A biopsy was taken, whenever deemed relevant. Advanced procedures such as enteroscopy or capsule endoscopy were not performed on these patients. Results: A total of 120 patients were evaluated for IDA. At least one GI lesion was found in 42.5% (n = 51) of patients. Upper GI (UGI) lesions (27.5%) were most commonly encountered, followed by lower GI lesions (9.1%). Conclusion: The patients with unexplained IDA were found to have a high incidence of GI lesions (42.5%). Hence, evaluation of the GI system with UGI endoscopy, colonoscopy, and mucosal biopsies in relevant patients is recommended for the determination of the cause of anemia.

P259 Clinical characteristics and long-term disease course in patients with Crohn’s disease diagnosed by video capsule endoscopy; A retrospective multicentre matched case-control study

Abstract Background Video capsule endoscopy (VCE) is a non-invasive and accurate diagnostic modality that allows for direct visualization of the small intestinal mucosa in Crohn’s disease (CD). In rare cases, lesions not detected by other diagnostic modalities in patients suspected to have CD are solely identified through VCE. We aim to evaluate the clinical characteristics and long-term outcomes of these rare cases. Methods A retrospective multicentre matched case-control analysis was conducted in patients with CD across three hospitals in Korea, from January 2007 to April 2023. To perform a matched case-control study, we defined cases (VCE group) as patients with normal findings at colonoscopy and cross-sectional imaging, ultimately diagnosed with CD by VCE; the controls were patients with CD diagnosed with specific findings at endoscopy or cross-sectional imaging (non-VCE group). Controls were matched to cases with a ratio of 3:1 for sex, calendar year of diagnosis, and age at diagnosis. Clinical characteristics and outcomes between the two groups were compared. Results Of the 3,137 patients diagnosed with CD during the study period, 24 were diagnosed solely by VCE. When compared to 72 matched patients with CD, the mean duration from symptom onset to diagnosis did not significantly differ (27.2 months [SD 10.2] vs. 25.3 months [SD 8.9], p=0.394). There was a significant difference in the proportion of Montreal behaviour (p<0.001). In the VCE group, non-stricturing and non-penetrating (B1) type and stricturing (B2) type accounted for 91.7 and 8.3%, respectively. However, there was no significant difference in the perianal fistula modifier (25% vs. 33.3%, p=0.446). Within the VCE group, 45.8% underwent the examination due to abdominal pain with diarrhoea, followed by 25.0% with perianal disease, and 20.8% with unexplained iron deficiency anaemia. Regarding capsule findings, the ileum was mostly involved (87.5%), while the jejunum and duodenum were affected in 70.8 and 16.7% of cases, respectively. Fifteen patients had two or three segments affected. The Median Lewis score was 838 [IQR 393–1803]. Concerning the cumulative incidence of clinical outcomes over 10 years, complicated behaviour, need for biologics, and CD-related hospitalization and surgery were all significantly lower in the VCE group than in the non-VCE group (p<0.005). Conclusion Patients diagnosed with CD solely by VCE are rare. In this study, they exhibited different clinical characteristics and a more favourable long-term disease course compared to the general population of patients with CD. This included a lower incidence of complicated behaviour, reduced need for biologics, and CD-related hospitalization and surgery.

Survival After Wait-and-See Approach in Older Patients With Unexplained Iron Deficiency Anemia in Primary Care: A Practice Evaluation

ObjectivesGuidelines recommend upper and lower gastrointestinal endoscopic evaluation for patients without a clear physiological explanation for iron deficiency anemia (IDA). However, the consequences of watchful waiting in older patients with unexplained IDA in general practice are unknown. The aim of this study was to investigate characteristics and survival of patients with an unexplained IDA in general practice who refrain from medical specialist evaluation. DesignHistorical prospective study. Setting and ParticipantsPatients aged ≥70 years with IDA coded in their medical records were selected from the Dutch Academic General Practitioner Development Network (AHON) database. MethodsBased on their medical records, patients with an unexplained IDA were classified as (1) referred for medical specialist evaluation, or (2) no or noninvasive evaluation in general practice. ResultsCompared to patients who were referred for medical specialist evaluation (n = 235, 47.8%), patients who had no or noninvasive evaluation (n = 257; 52.5%) were older (median respectively 79 vs 82 years old, P < .01) and more likely to have congestive heart failure (respectively 17.4% and 26.1%, P = .02) and dementia (respectively 2.6% and 8.9%, P < .01). Two-year survival was significantly higher in patients who were referred for medical specialist evaluation compared to patients who had no or noninvasive evaluation (respectively, 83.9% and 75.5%, P = .02). Conclusions and ImplicationsAlthough mortality was significantly higher in the older and more comorbid patients who had no or noninvasive evaluation in general practice, survival was still high in this patient group. Therefore, non–guideline adherence and a wait-and-see approach could be discussed in a shared–decision-making consultation.

S2450 When it Is Not Adenocarcinoma: Primary Squamous Cell Carcinoma of the Ascending Colon Presenting as Unexplained Iron Deficiency Anemia

S2450 When it Is Not Adenocarcinoma: Primary Squamous Cell Carcinoma of the Ascending Colon Presenting as Unexplained Iron Deficiency Anemia

Is Helicobacter Pylori a Reason for Unexplained Iron Deficiency Anemia: A Systematic Review.

Iron deficiency anemia (IDA) is a worldwide public health problem affecting millions, with developing nations accruing a significant disease burden. Helicobacter pylori (H. pylori) has been proposed in many studies as a causative factor for unexplained iron deficiency anemia. In this systematic review, we searched PubMed, Google Scholar, and ScienceDirect to come up with five cross-sectional studies and five Randomized Controlled Trials (RCTs), which evaluated the association between H. pylori and unexplained iron deficiency anemia and the response of IDA to anti-H. pylori therapy. H. pylori eradication therapy included triple therapy (proton pump inhibitor, clarithromycin, amoxicillin) or quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) for 10-14 days. Quadruple therapy was used if there is a penicillin allergy or a local antibiotic resistance level of more than 15% to clarithromycin. The cross-sectional studies concluded that H. pylori infection was associated with low serum ferritin levels. The RCTs confirmed that H. pylori are associated with iron deficiency anemia by demonstrating improvement in markers of iron status (ferritin, hemoglobin, Mean Corpuscular Volume (MCV), serum transferrin receptor levels) with H. pylori eradication therapy. In a nutshell, this systematic review concludes that H. pylori testing and treatment must be considered as a differential diagnosis of unexplained IDA in all age groups and serves as a benchmark for more randomized clinical trials to prove causation.

Asymptomatic jejunal metastatic melanoma. A case report of anemia of uncertain origin

Gastrointestinal metastases from cutaneous melanoma are rare and usually asymptomatic, with most patients not being clinically diagnosed throughout their lifetime. We report a case of how melanoma may metastasize insidiously in the small bowel. Unexplained iron deficiency anemia was assumed to be the result of underlying gastrointestinal bleeding. Therefore, the diagnosis of jejunal metastasis from cutaneous melanoma was suggested based on imaging findings and made through the histopathological examination. According to the international guidelines, the patient underwent the complete excision of the primary tumor and therapeutic lymph node dissection. Furthermore, an adjuvant treatment was required to reduce the risk of recurrence. Both immunotherapy and surgical therapy have been shown to be effective, providing long-term survival in this case.

Primary Care Provider Knowledge and Practice in Risk Assessment for Early Age Onset Colorectal Cancer: Opportunities for Improvement.

Colorectal cancer (CRC) incidence and mortality are rising in individuals under age 50, termed early age onset (EAO) CRC. Lower endoscopy is recommended for all patients with unexplained iron deficiency anemia (IDA) or hematochezia to assess the EAO-CRC. For those without symptoms, professional societies recommend decreasing the age to start screening from 50 to 45. Primary care provider (PCP) knowledge and practices around EAO-CRC risk assessment and screening are unknown. We conducted a survey study in May, 2020 of multi-specialty PCPs from three large medical systems to assess PCP knowledge, risk stratification practices and barriers/facilitators they face to offer CRC screening in patients < 50. We conducted univariate analysis to assess factors associated with knowledge and diagnostic practices. Response rate was 27.7% (196/708). Although 77.6% of respondents were aware that EAO-CRC incidence is increasing, only 42.9% knew that EAO-CRC mortality is also increasing. Of note, 91.8% recommend starting average risk screening at age 50. For 40- to 49-year-old patients present with unexplained IDA or hematochezia, 71.9% and 50.5% of respondents, respectively, recommend a diagnostic colonoscopy. Trainees were less likely to be aware of rising EAO-CRC mortality (odds ratio, 0.42; 95% CI, 0.21 to 0.82) and non-internal medicine providers were less likely to recommend CRC screening in those with a first-degree relative with CRC (odds ratio, 0.82; 95% CI, 0.72 to 0.93). Ongoing education efforts will be required to improve recognition and management of high-risk symptoms, particularly among non-internists and trainees.

TP7.2.11 Hypochromia is an early marker of iron deficiency anaemia

Abstract Aim Microcytosis in iron deficiency anaemia triggers an urgent referral for investigation of suspected gastrointestinal cancers. This study evaluated whether the inclusion of hypochromia as a marker for iron deficiency would lead to earlier referrals. Method Consecutive patients referred from primary care under the 2-week wait suspected gastrointestinal cancer pathway with unexplained iron deficiency anaemia between October 2019 and October 2020 were included. Results of red cell indices were obtained from an electronic platform for accessing laboratory test results(Sunquest ICE™, Version 5.4, Sunquest Information Systems). Mean corpuscular haemoglobin (MCH) of 27-32pg and mean corpuscular volume (MCV) of 80-102fL were considered normal. Results Seventy nine patients (32 men, 47 women) were included. Median (IQR) age was 73 (62-80) years. 67% (53/79) had a low MCH and 43% (34/79) had a low MCV at the time of referral. In the preceding months of referral (median [IQR] 4.3 [1.8-7.9] months) 64 patients had a full blood count performed of which 55% (35/64) had a low MCH and 20% (13/64) had a low MCV. The earliest available full blood count prior to referral (43 patients, median (IQR) of 16.5 (12-37) months) showed that 86% (37/43) had a low MCH compared to 33% (14/43) with a low MCV. A fall in MCH always preceded a fall in MCV at all the three time points analysed. Conclusion The inclusion of hypochromia as a marker of iron deficiency in the referral criteria for suspected gastrointestinal cancers would trigger significantly earlier referrals.

Video Capsule Endoscopy In Comparison To Radiological Examination In Detection Of Small Bowel Lesions

Abstract BACKGROUND Small bowel obscured its lesions as secrets which were difficult to diagnose before video capsule endoscopy as a new modality for investigation. Aim of the study Evaluation of video capsule endoscopy in comparison to radiological examination in detection of small bowel lesions. Patients and methods Fifty patients were recruited from Kafrawy Video Capsule Endoscopy Unit of Internal Medicine Department and endoscopy unit of Ain Shams University Hospital. The study included patients with occult or overt GIT bleeding, patients with unexplained microcytic iron deficiency anemia, patients with chronic diarrhea and abdominal pain, with normal upper GI endoscopy and colonoscopy. Exclusion of any patient younger than 18 years old, has intestinal stricture, achalasia, or dysphagia. All patients were studied biochemically with CBC and radiological by CT pelvis and abdomen with IV and oral positive contrast some of them were radiologically examined with CTE or CT mesenteric angiography. All patients were endoscopically examined by OGD, colonoscopy, VCE, and some of them were examined also with enteroscope. Results The study revealed that the detection rate of SB lesions with VCE was 84%. In the current study, (44%) of cases had AVMs, (72.73) % of them were above the age of forty five, and (27.27) % were below the age of forty five. All patients who were investigated with CT mesenteric angiography revealed negative results. In this study (20) % of patients had SB masses and polyps, (70) % of them were at age of forty five or more and only (30) % of them were below the age of forty five. All patients underwent CT pelvis and abdomen with IV and oral positive contrast, and we found that all patients had a negative results regarding the SB lesions. In comparison between CTE and VCE in detection of SB vascular lesions CTE did not detect SB vacular lesions. On the other hand, VCE detected the AVMs in the cases with negative CTE results. In this study one patient (2)% was diagnosed with hookworm infection. All patient underwent for OGD. We found that (20)% of patients had a significant gastric or duodenal lesions (proximal to the papilla) by VCE but missed by upper GI endoscopy. In our study the concomitant of VCE and enteroscope increase the detection of SB vascular lesions than isolated use of VCE only. Conclusion VCE has a high detection rate of SB lesions (84)%. CTE has a low significance in detection of SB vascular lesions and CT mesenteric angiography sensitivity relatively low. AVMs more common with increasing the age. PHE and SB ectopic varicies, were found to be common causes of GIT bleeding in CLD patient. There is a significant rate of missed gastric and duodenal (proximal to the papilla) lesions that the cause of GIT bleeding and unexplained iron deficiency anemia in OGD examination that were detected by VCE.

Helicobacter pylori and Respiratory Diseases: 2021 Update.

Helicobacter pylori (H. pylori) is a Gram-negative bacterium involved in the development of gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue. Unexplained iron deficiency anemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency have also been related to H. pylori infection, whereas for other extra-gastric diseases, the debate is still open. In this review, we evaluate and discuss the potential involvement of H. pylori infection in the pathogenesis of several respiratory diseases. A MEDLINE search of all studies published in English from 1965 to 2021 was carried out. Controversial findings have been reported in patients with bronchial asthma, chronic obstructive pulmonary disease, bronchiectasis, lung cancer, tuberculosis, cystic fibrosis, and sarcoidosis. Most of the available literature is concerned with case-control studies based on seroprevalence, with a small sample size and low consideration of confounders, which represents a potential issue. So far, there is no clear evidence of a causal association between H. pylori infection and respiratory diseases, and larger studies with appropriate epidemiological design are required.

Anemia in Sports: A Narrative Review.

Recent years have brought about new understandings regarding the pathogenesis of anemia in sports. From hemodilution and redistribution considered to contribute to the so-called “sports anemia” to iron deficiency caused by increased demands, dietary restrictions, decreased absorption, increased losses, hemolysis, and sequestration, to genetic determinants of different types of anemia (some related to sport), the anemia in athletes deserves a careful and multifactorial approach. Dietary factors that reduce iron absorption (e.g., phytate, polyphenols) and that augment iron’s bioavailability (e.g., ascorbic acid) should be considered. Celiac disease, more prevalent in female athletes, may underlie an unexplained iron deficiency anemia. Iron loss during exercise occurs in several ways: sweating, hematuria, gastrointestinal bleeding, inflammation, and intravascular and extravascular hemolysis. From a practical point of view, assessing iron status, especially in the athletes at risk for iron deficiency (females, adolescents, in sports with dietary restrictions, etc.), may improve the iron balance and possibly the performance. Hemoglobin and serum ferritin are measures that are easily employable for the evaluation of patients’ iron status. Cutoff values should probably be further assessed with respect to the sex, age, and type of sport. A healthy gut microbiome influences the iron status. Athletes at risk of iron deficiency should perform non-weight-bearing, low-intensity sports to avoid inducing hemolysis.

Relationship between Hepcidin and Iron Deficiency Anemia in Helicobacter pylori Infected Patients

Background: Helicobacter pylori may be associated with unexplained iron-deficiency anemia (IDA). Hepcidin is an acute-phase reactant but its relation to H. pylori and IDA has not been elucidated. Objective: to investigate serum hepcidin in H. pylori infected patients and its role in IDA. Methodology: This study was performed on 70 patients infected by Helicobacter pylori. They were divided into two groups, group A: 35 H. pylori infected patients without iron deficiency anemia and group B: 35 H. pylori infected patients with iron deficiency anemia. Serum hepcidin was measured by ELISA in both groups while iron, ferritin and total iron binding capacity were estimated in group B. Results: Serum hepcidin was significantly higher in patients with H. pylori infection and iron deficiency anemia. However, non-significant correlation between hepcidin and both iron and ferritin were found. Conclusion: Helicobacter pylori could modulate serum hepcidin level in patients with iron deficiency anemia.

Impact of Helicobacter pylori on hematological parameters among Saudi population.

Objectives:To investigate prevalence and association between iron deficiency anemia (IDA) and Helicobacter pylori (H. pylori).Methods:This cross-sectional study included 79 participants with unexplained IDA. The study was carried out between November 2018 to April 2020 in the College of Medicine, Umm Al-Qura University in collaboration with Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Complete blood count (CBC), serum iron, and ferritin levels were measured. Anti-H. pylori antibody was detected using anti-H. pylori immunoglobulin G enzyme-linked immunosorbent assay (ELISA).Results:The prevalence of H. pylori infection among IDA patients was 62%. There was a significant difference between female and male subjects with a positive H. pylori status (p=0.001). There was also a significant difference between females and males with a positive H. pylori infection according to red blood cell count, hematocrit, mean corpuscular volume, and mean cor-puscular hemoglobin (p=0.001).Conclusion:The current study shows an association between H. pylori infection and unexplained IDA with significant difference between postmenopausal Saudi females and males. This will lead to more effective treatment in IDA and the eradication of H. pylori, as well as the prevention of recurrence, which are necessary and may provide a significant reduction in the overall disease burden.

A146 EVALUATION OF A COLONOSCOPY REFERRAL FORM IN QUEBEC: WHICH INDICATIONS CARRIES A HIGHER RISK OF ADVANCED NEOPLASIA?

BackgroundPatients referral for colonoscopy in the province of Quebec are organized through a standardized triage sheet that includes all indications categorized in 5 hierarchal scheduling priorities. In the context of a restricted access to colonoscopy, exacerbated by the COVID-19 pandemic, postponed elective endoscopies lead to potential diagnostic and therapeutic delays in patients with colorectal neoplasia. There is currently an important need to evaluate available tools to improve patients prioritization.AimsThis study aims to determine CRC and advanced adenomas (AA) rates associated with indications of priority 3 (P3 fig.1). The secondary objective is to regroup and compare indications with higher and lower rate of CRC and AA.MethodsThis retrospective study included all adult patients who underwent a single diagnostic colonoscopy from March 2013 to March 2016 following a single FIT test in a tertiary teaching hospital. A literature review informed the adopted definition of higher-risk of CRC and AA according to P3 colonoscopy indications. These include: Positive FIT test (IN5), hematochezia in ≥ 40 years old patients (IN4), unexplained iron deficiency anemia (IN6) and symptoms suspicious of occult colorectal cancer (IN18). Lower risk P3 indications were defined as: suspicion of IBD (IN3), recent change in bowel habits (IN7), polyp viewed on imaging (IN17), inadequate bowel preparation (IN19), and diverticulitis follow-up (IN20). Higher and lower risk indications findings were analyzed.ResultsIn our cohort of 2226 patients, indications for colonoscopy referral according to the standardized form were available for 1806 patients (10 P1, 69 P2, 1056 P3, 56 P4 and 615 P5). In our studied group of P3 indications, the mean age was 62.6±11.3 years, 54.1% were female and 173 (16.4%) patients had a significant finding of CRC or AA (table 1). Patients referred for higher risk indications had a significantly increased rate of CRC and AA (19.3% vs 5.1% p≤ 0.01) compared to patients referred for lower risk indications.ConclusionsA standardized colonoscopy referral tool may be adapted to improve prioritization of patients at risk of advanced neoplasia. These findings are especially relevant in the context of limited access to colonoscopy like during a pandemic.Table 1. Detection rate of neoplastic findings for P3 indications(%) Higher-risk indications Lower-risk indications IN4 (N=230)IN5 (N=453)IN6 (N=156)IN18 (N=3)IN3 (N=41)IN7 (N=135)IN17 (N=5)IN20 (N=33) Non-advanced adenomas (NAA)47(20.4)192(42.6)41(26.5)1(33)5(12.2)25(18.5)4(80)6(18.2) Advanced adenomas (AA)21(9.2)116(25.7)8(5.2)01(2.4)8(5.9)01(3) Serrated polyps 11(4.8)42(9.4)5(3.2)006(4.5)01(3) Carcinoma (CRC)5(2.2)7(1.6)6(3.9)001(0.7)00 AA and CRC 26(11.3)123(27.2)14(9.0)01(2.4)9(6.6)01(3)Figure 1: Provincial colonoscopy referral form in Quebec (AH-702)Funding AgenciesNone

Non-steroidal anti-inflammatory drugs and the gastrointestinal tract

Non-steroidal anti-inflammatory drugs (NSAIDs) are used commonly but can cause foregut symptoms, peptic ulcer disease and small bowel enteropathy. Such iatrogenic injury can be complicated by gastrointestinal bleeding and perforation. Limiting NSAID use or co-administration with proton pump inhibitors (PPIs) reduce dyspepsia, peptic ulcer disease and rates of complications. Selective cyclo-oxygenase (COX)-2 inhibitors are as effective as adding PPIs in preventing upper and lower gastrointestinal complications. COX-2 inhibitors are suggested in those with high cardiovascular risk and the addition of PPI in those with high risk of bleeding. Where required, COX-2 inhibitor monotherapy may be preferred in unexplained iron deficiency anaemia.

Helicobacter pylori : quand rechercher une infection et la traiter chez l’adulte ?

Helicobacter pylori infection is acquired during childhood mainly within the family. It causes active chronic gastritis associated with the development of many digestive and extra digestive diseases. Its expression results from interactions between the bacteria, the host and environmental factors modulating the evolution of gastritis and acid secretion. The French recommendations for research and treatment for curative or preventive purposes were updated in 2017. These are indications with a high level of evidence for association and efficacy of the eradication treatment: peptic ulcer, taking non-steroidal anti-inflammatory drugs or aspirin with an ulcer history, gastric MALT lymphoma, and localized resection of gastric cancer. The recommendations relate to other diseases with a lower level of evidence: functional dyspepsia, risk factors for gastric adenocarcinoma (family history of gastric cancer, Lynch syndrome, pre-neoplastic lesions: atrophy, intestinal metaplasia, dysplasia), unexplained iron deficiency anemia and vitamin B12 deficiency, immunological thrombocytopenic purpura, bariatric surgery isolating part of the stomach. The diagnosis is made by examining gastric biopsies or by non-invasive test depending on the clinical situation. The 10-day triple therapies guided by the study of antibiotic sensitivity (proton pump inhibitors (PPI), amoxicillin, clarithromycin or levofloxacin) are recommended as first-line treatment because of the increase in resistance, allowing the reduction of the duration of treatment, the number of antibiotics and side effects. By default, probabilistic quadruple therapies of 14 days are possible and interchangeable (PPI with amoxicillin, clarithromycin, metronidazole, or a combination of bismuth salt, tetracycline and metronidazole). Eradication control is necessary.

Upper and Lower Gastrointestinal Endoscopic Lesions in Patients with Unexplained Iron Deficiency Anaemia- A Cross-sectional Study

Introduction: Anaemia, due to iron deficiency, is very common in India. In many cases, the underlying cause of iron deficiency remains unknown even after detailed laboratory investigations. It is often due to malabsorption of iron from the gut and occult blood loss from the Gastrointestinal (GI) tract. Bidirectional GI endoscopy can help in finding these causes. Aim: To study the upper and lower GI endoscopic lesions in patients with unexplained Iron Deficiency Anaemia (IDA). Materials and Methods: This was a cross-sectional observational study, conducted on 75 patients with unexplained IDA in Dr. DY Patil Medical College and Hospital, Pune, Maharashtra, India, between June 2019 to June 2020. Patients above the age of 18 years and with Haemoglobin (Hb) of less than 13 g/dL (males) and less than 12 g/dL (females) underwent upper GI endoscopy and colonoscopy with biopsies, after ethics committee approval and informed consent. Complete haemogram with blood indices, iron studies and faecal Occult Blood Test (OBT) were conducted for all the patients. The patients were divided into Group A, those with upper/lower GI endoscopy lesions thought to be responsible for IDA and Group B, those without GI endoscopic lesions. Statistical analysis was performed using IBM, Statistical Package for the Social Sciences (SPSS), version 21.0 and statistical tests (Chi-square test, Student’s t-test and multivariate logistic regression analysis, with 95% Confidence Interval (CI) and p-value &lt;0.05 was taken as significant) were used when required. Results: There were 44 females and 31 males in the study, with the age range of 20-81 years. The mean age of patients in Group A (n=44) was 58.57±11.68 years and Group B (n=31) was 49.68±14.45 years. On multivariate analysis, advance age, history of weight loss and faecal occult blood were statistically significantly associated with the presence of GI endoscopic lesions responsible for IDA (p-value&lt;0.05). Maximum lesions responsible for IDA were found in stomach (48%), erosive and inflammatory lesions causing IDA were more common in upper GI tract. Peptic ulcers were found in 12% cases. The GI malignancies were found in 14.66% subjects. Colorectal cancers (8%) were more common than upper GI cancers (6.66%). Conclusion: In patients with IDA, erosive oesophagitis and haemorrhagic gastritis were commonly found followed by peptic ulcers and malignant GI lesions on bidirectional endoscopy. GI endoscopy is a very important tool to diagnose the cause of IDA. All patients with advanced age, history of weight loss and a positive faecal OBT should undergo bidirectional GI endoscopy routinely.

Single-balloon enteroscopy in management of small-bowel disorders.

Device-assisted enteroscopy including single-balloon enteroscopy (SBE) allows direct visualization of the small bowel and has good safety and efficacy in experienced hands. Our study is aimed to share our single-centre experience of SBE in diagnosing and treating small-bowel disorders. We reviewed the prospectively collected data (from December 2016 to December 2019) of 180 consecutive anterograde and/or retrograde procedures. Analysis of baseline characteristics, endoscopic findings, and diagnostic and therapeutic rates was done. SBE was done in 158 patients with a median age of 55years (range, 13-94years) for suspected small-bowel lesions. Dual enteroscopy (anterograde plus retrograde) was done in 22 patients (13.92%). The indication for the procedure was obscure gastrointestinal bleeding in 129 (71.66%), chronic unexplained abdominal pain in 20 (11.11%), suspected small-bowel abnormality in the form of narrowing and/or mass on imaging in 10 (5.5%), chronic diarrhea in 9 (5%), unexplained iron deficiency anemia in 9 (5%), and retained capsule in 2 (1.11%). The most common finding was ulcer, which was noted in 45 (25%) patients followed by stricture in 8 (4.44%) and both ulcers and strictures in 6 (3.33%) patients. SBE was normal in 61 (33.88%) patients. SBE gave a diagnosis in 66.11% while in 28.43% cases, therapeutic intervention was done. Minor complications like bleeding were noted in 3 patients and mild acute pancreatitis in 2 patients. Jejunal perforation requiring surgical intervention was noted in 1 patient. SBE is a safe and effective procedure in diagnosing and treating small-bowel diseases.

Positive Fecal Occult Blood Test is a Predictive Factor for Gastrointestinal Bleeding after Capsule Endoscopy in Patients with Unexplained Iron Deficiency Anemia: A Korean Multicenter CAPENTRY Study.

Background/AimsCapsule endoscopy (CE) is recommended as the primary method for the evaluation of unexplained anemia. This study aimed to assess the diagnostic yield of CE in patients with unexplained iron deficiency anemia (IDA) without overt bleeding, and to evaluate their long-term outcomes and related clinical factors. MethodsData of patients who underwent CE for the evaluation of IDA were reviewed from a CE registry in Korea. Additional clinical data were collected by the involved investigators of each hospital through a review of medical records. ResultsAmong a total of 144 patients, the diagnostic yield of CE was 34%. Gastrointestinal (GI) bleeding was found in 6.3% (n=9) of the patients (occult bleeding in four patients and overt bleeding in five patients) during a mean follow-up of 17.8 months. Patients with a positive fecal occult blood test (FOBT) result at the initial diagnosis had a higher rate of GI bleeding after CE (p=0.004). In addition, a positive FOBT result was the only independent predictive factor for GI bleeding (hazard ratio, 5.30; 95% confidence interval, 1.41–19.85; p=0.013). ConclusionsPositive FOBT is a predictive factor for GI bleeding during follow-up after CE in patients with unexplained IDA without overt bleeding. Thus, patients with positive FOBT need to be more closely followed up.