Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms
Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms
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DOI：
10.1016/s0002-9343(01)00883-x
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发表时间：
2001-10-15
影响因子：
5.9
通讯作者：
DelleFave, G
中科院分区：
文献类型：
--
作者：
Annibale, B;Capurso, G;DelleFave, G
背景：缺铁性贫血患者的标准评估包括对胃肠道进行全面评估，以确定出血来源。然而，即使经过仔细检查，许多患者仍然没有得到诊断。由于缺铁性贫血是由铁丢失或吸收缺陷引起的，因此我们试图确定无胃肠道症状的患者中缺铁性贫血的潜在胃肠道来源的患病率。方法：在 10 个月的时间里，668 名门诊患者被转诊至大学血液科，患有缺铁性贫血，定义为血红蛋白浓度低于 14 g/dL（低于 12 g/dL） 女性），平均红细胞体积小于 80 fL，铁蛋白水平小于 30 mug/L。排除因明显失血、饮食不当、慢性病或恶性肿瘤等原因导致的患者后，符合条件的患者有81名，其中10名拒绝调查。其余 71 名患者（51 名女性，中位年龄 59 岁）接受了结肠镜检查以及胃镜检查，并进行了胃（胃窦和胃体）和十二指肠活检。 结果：在 60 名患者（85%）中检测到了缺铁性贫血的可能原因。 26例患者（37%）发现与出血相关的疾病，包括结肠癌（10例）、胃癌（2例）、消化性溃疡（7例）、食管裂孔疝伴线状糜烂（5例）、结肠血管扩张（3例）、结肠息肉（2例）和克罗恩病（1例）。 36 名患者 (51%) 发现了与出血无关的原因，其中 19 名患有萎缩性胃炎，4 名患有乳糜泻，13 名患有幽门螺杆菌胃炎。 6 名 (8%) 患者有一致的胃肠道检查结果，11 名 (15%) 患者没有确定原因。已确定的非出血相关原因的患者比出血相关原因的患者更年轻（中位年龄分别为 56 岁与 70 岁；P = 0.001），并且包括 59% 的女性 (n = 30) 和 30% 的男性 (n = 6) (P = 0.04)。血红蛋白水平与疾病部位和严重程度无关。结论：通常不引起出血的胃肠道疾病通常与没有胃肠道症状或其他潜在胃肠道出血原因的患者发生缺铁性贫血相关。 (C) 2001 年，Excerpta Medica, Inc.
BACKGROUND: The standard evaluation of a patient with iron deficiency anemia includes a complete evaluation of the gastrointestinal tract to identify a source of bleeding. However, even after a careful examination, many patients remain without a diagnosis. Because iron deficiency anemia results from iron loss or defective absorption, we sought to determine the prevalence of potential gastrointestinal sources for iron deficiency anemia in patients without gastrointestinal Symptoms.METHODS: Over a 10-month period, 668 outpatients were referred to the University Hematology Department with iron deficiency anemia, defined by a hemoglobin concentration less than 14 g/dL (less than 12 g/dL in women), mean corpuscular volume less than 80 fL, and ferritin level less than 30 mug/L. After excluding patients with obvious causes of blood loss, inadequate diet, chronic diseases, or malignancies, there were 81 eligible patients, 10 of whom refused investigation. The remaining 71 patients (51 women, median age 59 years) underwent colonoscopy, as well as gastroscopy, with gastric (antrum and body) and duodenal biopsies.RESULTS: A likely cause of iron deficiency anemia was detected in 60 patients (85%). Diseases associated with bleeding were found in 26 patients (37%), including colon cancer (10 patients), gastric cancer (2), peptic ulcer (7), hiatal hernia with linear erosions (5), colonic vascular ectasia (3), colonic polyps (2), and Crohn's disease (1). Causes not associated with bleeding were found in 36 patients (51%), including 19 with atrophic,gastritis, 4 with celiac disease, and 13 with Helicobacter pylori gastritis. Six (8%) patients had coincident gastrointestinal findings, and 11 (15%) had no cause identified. Patients with an identified nonbleeding-associated cause were younger than those with a bleeding-associated cause (median, 56 vs 70 years; P = 0.001) and included 59% of women (n = 30) versus 30% of men (n = 6) (P = 0.04). Hemoglobin level was not related to the site and severity of disease.CONCLUSION: Gastrointestinal diseases that do not usually cause bleeding are frequently associated with iron deficiency anemia in patients without gastrointestinal symptom or other potential causes of gastrointestinal bleeding. (C) 2001 by Excerpta Medica, Inc.