Outcome of gastrointestinal (GI) tract work up in menstruating females with iron deficiency anemia

AIM: To assess the yield of gastrointestinal tract work-up in menstruating females with iron deficiency anemia. METHOD: All menstruating females with anemia referred to our clinic were first evaluated for iron deficiency by measuring serum iron, total iron binding capacity and ferritin levels. Those confirmed to have iron deficiency were evaluated with a detailed history including menstrual history, thorough physical examination including stool guaiac followed by upper and lower GI tract evaluation either endoscopically or radiographically. RESULTS: 60 females (ages 38-57) were confirmed to have iron deficiency anemia. Eight had lower GI symptoms, 6 of whom had bright red blood per rectum and 2 had left lower quadrant pain. 14 had upper GI symptoms, 12 of whom had epigastric pain and 2 had reflux symptoms. 16 had guaiac positive stool. 50 patients had colonoscopies and 15 had barium enemas. Positive findings included a 4cm villous adenoma (1 patient) and a 5 mm tubular adenoma (2 patients). 21 patients had esophagogastroduodenoscopy of which 2 had esophagitis, 2 had duodenal ulcer and 1 had a benign gastric ulcer. All patients had small bowel series which were within normal limits. Of the 8 patients with positive findings 6 had been found to have guaiac positive stool and 4 had been symptomatic. Only 1 patient had a positive finding despite a lack of signs or symptoms. Although 8 patients had positive findings in our view none of the findings was the primary cause of the iron deficiency. CONCLUSION: Although a GI tract work up in menstruating females with iron deficiency anemia yielded significant findings, the yield was dramatically improved by limiting the investigation to those with GI symptoms or occult blood in the stool.