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Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia.
Am J Gastroenterol. 1996 Oct; 91(10):2099-102.AJ

Abstract

OBJECTIVES

The recommended evaluation of adult patients presenting with iron deficiency anemia (IDA) includes the performance of colonoscopy and esophagogastroduodenoscopy. IDA is a common feature in patients with celiac disease and, in several, may be the only presenting sign. The performance of small bowel biopsy (SBB) for the evaluation of celiac disease as the cause of IDA is not routinely recommended. The aim of the present study was to determine the yield of SBB performed during routine endoscopy of adults with IDA.

METHODS

We prospectively studied 93 patients with IDA. Three control groups were included: 23 patients with steatorrhea, 37 patients with idiopathic diarrhea, and 9 patients in whom SBB was performed for miscellaneous indications.

RESULTS

Eleven patients with IDA and two patients with steatorrhea had SBB findings compatible with celiac disease. None of the patients from the other two groups had similar findings. Two patients with IDA, who were later diagnosed to suffer from celiac disease, presented: one with occult blood in the stool and the other with rectal bleeding. Subgroup analysis of patients with IDA revealed that patients with celiac disease were younger, had significantly more episodes of diarrhea, lower mean hemoglobin level, and longer duration of anemia than those without celiac disease. Other mucosal abnormalities were found in a substantial number of patients with celiac disease: esophagitis, gastritis, duodenitis, hemorrhoids, and colitis.

CONCLUSIONS

A substantial number of adult Israeli patients who present with IDA are found, on SBB, to have mucosal abnormalities compatible with the diagnosis of celiac disease. The presence of esophagitis, gastritis, or duodenitis on esophagogastroduodenoscopy, or other abnormalities on colonoscopy, do not exclude the coexistence of celiac disease. Celiac disease should be included and routinely looked for in the differential diagnosis of adult patients with IDA.

Authors+Show Affiliations

Department of Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8855729

Citation

Ackerman, Z, et al. "Role of Small Bowel Biopsy in the Endoscopic Evaluation of Adults With Iron Deficiency Anemia." The American Journal of Gastroenterology, vol. 91, no. 10, 1996, pp. 2099-102.
Ackerman Z, Eliakim R, Stalnikowicz R, et al. Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol. 1996;91(10):2099-102.
Ackerman, Z., Eliakim, R., Stalnikowicz, R., & Rachmilewitz, D. (1996). Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. The American Journal of Gastroenterology, 91(10), 2099-102.
Ackerman Z, et al. Role of Small Bowel Biopsy in the Endoscopic Evaluation of Adults With Iron Deficiency Anemia. Am J Gastroenterol. 1996;91(10):2099-102. PubMed PMID: 8855729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. AU - Ackerman,Z, AU - Eliakim,R, AU - Stalnikowicz,R, AU - Rachmilewitz,D, PY - 1996/10/1/pubmed PY - 1996/10/1/medline PY - 1996/10/1/entrez SP - 2099 EP - 102 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 91 IS - 10 N2 - OBJECTIVES: The recommended evaluation of adult patients presenting with iron deficiency anemia (IDA) includes the performance of colonoscopy and esophagogastroduodenoscopy. IDA is a common feature in patients with celiac disease and, in several, may be the only presenting sign. The performance of small bowel biopsy (SBB) for the evaluation of celiac disease as the cause of IDA is not routinely recommended. The aim of the present study was to determine the yield of SBB performed during routine endoscopy of adults with IDA. METHODS: We prospectively studied 93 patients with IDA. Three control groups were included: 23 patients with steatorrhea, 37 patients with idiopathic diarrhea, and 9 patients in whom SBB was performed for miscellaneous indications. RESULTS: Eleven patients with IDA and two patients with steatorrhea had SBB findings compatible with celiac disease. None of the patients from the other two groups had similar findings. Two patients with IDA, who were later diagnosed to suffer from celiac disease, presented: one with occult blood in the stool and the other with rectal bleeding. Subgroup analysis of patients with IDA revealed that patients with celiac disease were younger, had significantly more episodes of diarrhea, lower mean hemoglobin level, and longer duration of anemia than those without celiac disease. Other mucosal abnormalities were found in a substantial number of patients with celiac disease: esophagitis, gastritis, duodenitis, hemorrhoids, and colitis. CONCLUSIONS: A substantial number of adult Israeli patients who present with IDA are found, on SBB, to have mucosal abnormalities compatible with the diagnosis of celiac disease. The presence of esophagitis, gastritis, or duodenitis on esophagogastroduodenoscopy, or other abnormalities on colonoscopy, do not exclude the coexistence of celiac disease. Celiac disease should be included and routinely looked for in the differential diagnosis of adult patients with IDA. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/8855729/Role_of_small_bowel_biopsy_in_the_endoscopic_evaluation_of_adults_with_iron_deficiency_anemia_ L2 - http://www.diseaseinfosearch.org/result/3873 DB - PRIME DP - Unbound Medicine ER -