The Diagnostic Yield of Upper GI Endoscopy in Patients Iron Deficiency Anemia and/or Chronic Diarrhea

Abstract

Voulgaris T, Tampaki M, Laoudi E, Karatzas P, Karamanolis G, Vlachogiannakos J, Papaxoinis K, Kamberoglou D and Papatheodoridis G

Aim of the study: According to published guidelines, an upper gastrointestinal (GI) endoscopy with duodenal biopsy sampling should be performed in patients with iron deficiency anemia (IDA) and/or chronic diarrhea. The cost-effectiveness of this strategy in the absence of obvious endoscopic reason explaining patients’ symptoms has not been thoroughly investigated. Aim of our study was to access the clinical benefit of such a strategy.

Patients-Methods: All patients who underwent an upper GI endoscopy in our department due to IDA and/ or chronic diarrhea during a 5-year period (1/2015-12/2019) were included in our study. Epidemiological, endoscopic and histologic data were analyzed.

Results: The indication for endoscopy was IDA in 350 and chronic diarrhea in 108 patients; histological reports were available in 311 and 100 patients, respectively. Visual abnormalities were observed in 157 patients (34.3% in total; IDA: 32.9%, chronic diarrhea: 38.9%) and were more frequent among males than females (44.6% vs 33.5%, p=0.019) and among older patients (mean age 60 vs 56 years old, p=0.006). The histology report provided a conclusive diagnosis in 71/413 patients (17.2% in total; IDA: 14.8 %, chronic diarrhea: 25%). Celiac disease (CD) was diagnosed in 7.5% of our total study group. Normal endoscopic appearance of the duodenum was observed in 33% of patients, while bulb atrophy was associated more frequently with a conclusive histological report compared to other or no endoscopic findings (23/63 or 36.5% vs 48/350 or 13,7%, p<0,001).

Conclusions: Duodenal biopsy can aid significantly in the diagnosis of IDA or chronic diarrhea, even among patients without endoscopically abnormalities. Duodenal atrophy is an endoscopic marker that may lead to a conclusive histological diagnosis, most commonly CD, in 1 out of 3 patients.

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