Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia

Abstract

Purpose: Iron deficiency anemia is often attributed to menstrual blood loss in premenopausal women. The aims of this study were to determine the diagnostic yield of endoscopy and to evaluate the clinical outcome in these women.

Methods: Charts, endoscopy records, and pathology reports were reviewed in consecutive premenopausal women with documented iron deficiency anemia who were referred for diagnostic endoscopy. Follow-up was obtained by telephone contact and review of medical records.

Results: Endoscopy revealed a clinically important lesion in 23 (12%) of 186 patients. An upper gastrointestinal source was identified in 12 patients, most commonly due to gastric cancer (3%) or peptic ulcer disease (3%). A colonic lesion was detected in 11 patients, with colon cancer in six (3%). No patient had a lesion identified in both the upper and lower gastrointestinal tract. Small bowel biopsies and radiography were normal in all patients in whom they were obtained. Independent predictors for having a gastrointestinal lesion identified by endoscopy include a positive fecal occult blood test, a hemoglobin of <10 g/dL, and abdominal symptoms. Long-term follow-up data suggested a favorable prognosis, and iron deficiency anemia resolved with appropriate therapy in nearly all patients.

Conclusions: Endoscopy yields important findings in premenopausal women with iron deficiency anemia, which should not be attributed solely to menstrual blood loss.