P2503 - Asymptomatic Iron Deficiency Anemia in the U.S. Navy Male Recruit: Outcomes Following Bidirectional Endoscopy

Daniel J. Rausa, DO¹, Nehal Patel, MD², Shreya Desai, MD², David You, MD^3
1Captain James A. Lovell Federal Health Care Center, Elmhurst, IL; ²Rosalind Franklin University of Medicine and Science, North Chicago, IL; ³Captain James A. Lovell Federal Health Care Center, North Chicago, IL

Introduction: The finding of iron deficiency anemia (IDA) in asymptomatic men is considered an ominous sign and serious gastrointestinal disease (i.e. malignancy) must be considered. While recent guidelines from the American Gastroenterological Association recommend evaluation of IDA with bidirectional endoscopy for asymptomatic men and postmenopausal women in the absence of a clear etiology, little is known about diagnostic yield of this approach for asymptomatic young males. We sought to determine the common gastrointestinal diagnoses following bidirectional endoscopy for this subgroup and provide insight regarding the benefit of this approach among healthy young males who were diagnosed with IDA during medical screening for special military duty.

Methods: A retrospective descriptive chart review of male United States Navy recruits diagnosed with IDA (hemoglobin < 13 g/dL and ferritin < 45 mg/ml) in the absence of symptoms on routine medical screening for special military duty.

Results: 60 male recruits were referred to gastroenterology for asymptomatic IDA. 48 recruits underwent bidirectional endoscopy as no other possible cause could be determined on initial evaluation. 34 recruits received serologic testing for celiac disease with tissue transglutaminase (tTG)-IgA antibodies, of which 3 were positive. 6 recruits in total were diagnosed with celiac disease following histologic evaluation. 8 recruits received H. pylori stool antigen testing, of which 2 were positive. 6 recruits in total were found to have H. pylori infection following gastric biopsy. 17 recruits were found to have nonspecific inactive gastritis. 2 recruits were diagnosed with inflammatory bowel disease. Gastrointestinal malignancy was not noted in the study population.

Discussion: Based on this retrospective analysis, non-specific gastritis, celiac disease and H.pylori infection were the most common diagnosis following bidirectional endoscopy. Non-invasive testing for H. pylori with stool antigen testing was heavily underutilized. Our findings support the low prevalence of serious gastrointestinal disease in young, otherwise healthy asymptomatic males with IDA. These results indicate the need for additional research to assess the clinical benefit and cost-effectiveness of a non-invasive testing strategy for celiac disease and H. pylori with conservative management against bidirectional endoscopy and histologic assessment in this population at low risk for serious gastrointestinal disease.


Disclosures:
Daniel Rausa indicated no relevant financial relationships.
Nehal Patel indicated no relevant financial relationships.
Shreya Desai indicated no relevant financial relationships.
David You indicated no relevant financial relationships.


Daniel J. Rausa, DO¹, Nehal Patel, MD², Shreya Desai, MD², David You, MD³. P2503 - Asymptomatic Iron Deficiency Anemia in the U.S. Navy Male Recruit: Outcomes Following Bidirectional Endoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.