[How to explore iron-deficiency anemia]

Abstract

Only one third of anemias diagnosed in patients older than 65 years are iron-deficiency anemias. In these iron-deficiency anemias after 65 years, bidirectional endoscopy diagnoses a cause in up to 90% of cases. In case of negative bidirectional endoscopy, capsule endoscopy is clearly the best approach. After a negative capsule, a new bidirectional endoscopy for the detection of previously missed lesions is the recommended option. In young women with anemia is much more often an iron-deficiency anemia. The causes of this anemia can be multiple: low iron-intake, gynaecologic, and finally digestive. A step-by-step approach is thus of utmost importance to avoid unjustified examinations. In case of digestive symptoms, an upper (or in rare cases lower) endoscopy can be justified, major diagnoses being Helicobacter Pylor gastritis and celiac disease. The clinical relevance of capsule endoscopy is poorly evaluated in this group of patients, and seems of minimal impact.