P2500 - High Yield of Relevant GI Endoscopic Findings in Patients With Unexplained Iron Deficiency Without Anemia

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Yinglin Gao, DO

Loma Linda University Medical Center
Loma Linda, CA, United States

Yinglin Gao, DO¹, Sneha Shaha, DO¹, Kenneth Leung, MD², Eric Imbertson, MD³, Muhammad B. Hammami, MD⁴
¹Loma Linda University Medical Center, Loma Linda, CA; ²University of California Riverside School of Medicine, Loma Linda, CA; ³VA Loma Linda Healthcare System, Loma Linda, CA; ⁴VA Loma Linda Healthcare System, Rancho Cucamonga, CA

Introduction: GI endoscopy is recommended for the work-up of unexplained iron deficiency anemia (IDA). However, there are no established guidelines regarding its role in iron deficiency without anemia (IDWA). Therefore, we explored the yield of GI luminal evaluation in patients with IDWA.

Methods: We retrospectively reviewed the GI work-up of all patients evaluated between January 1st, 2016 and December 31st, 2020 at the Loma Linda Veterans Affairs Healthcare System GI clinic who had a hemoglobin (HGB) level greater than or equal to 13 and 12 gm/dl in men and women, respectively, and serum ferritin (FR) level of less than 45 ng/dL.

Results: Fifty-nine patients fulfilled the inclusion criteria and were cared for by 12 different staff members (23 (40%) also by GI fellow). Their mean (SD) age was 68 (11) years, Hgb level was 13.9 gm/dL (1.6), and FR was 18.6 (9.88) ng/dl. Fifty-seven (96%) were males; 6 (10.2%) underwent colonoscopy (cscope), esophagogastroduodenoscopy (EGD), and video capsule endoscopy (VCE), 16 (27.1%) cscope and EGD only, 3 (5%) EGD and VCE only, 6 (10.2%) cscope only, 2 (3.4%) EGD only, 2 (3.4%) VCE only, and 24 (40.7%) had no luminal evaluation. The endoscopic findings are summarized in Table 1. One or more iron deficiency-relevant findings were seen in 31 (88.6%) of the 35 patients who underwent luminal evaluation (31 (52.5%) of the total 59 patients).

Discussion: Our study demonstrates a considerable variation in the management of patients with IDWA between providers, which may be due to a lack of guidelines. Further, the study suggests a high yield of iron deficiency-relevant endoscopic findings in patients with IDWA. Therefore, it may be prudent to offer luminal GI evaluation to all patients with unexplained iron deficiency regardless of the presence of anemia.

EGD (n=27)	Colonoscopy (n=28)	VCE (n=11)
Erosive esophagitis: 3 (11.1%)	Advanced adenoma(s): 4 (14.3%)	Ulcer: 2 (18.2%)
Barrett’s esophagus: 4 (14.8%)	Any polyp(s): 15 (53.6%)	Angiodysplasia: 1 (9%)
Gastritis: 9 (33.3%)	Angiodysplasia: 2 (7.1%)	Lymphangiectasia: 3 (18.2%)
Duodenitis: 3 (11.1%)	Hemorrhoid(s): 8 (28.6%)	Duodenitis: 1 (9%)
Gastric antral vascular ectasia: 1 (3.7%)	Diverticulosis: 6 (21.4%)	Normal: 4 (36.3%)
Portal hypertensive gastropathy: 2 (7.4%)	Colitis: 1 (3.6%)
Esophageal varices: 1 (3.7%)	Normal: 3 (10.7%)
Schatzki ring: 1 (1.7%)
Gastric polyp(s): 3 (11.1%)
Duodenal polyp(s): 1 (3.7%)
Normal: 8 (29.6%)

Data present number (percent) of patients. EGD indicates esophagogastroduodenoscopy, VCE indicates video capsule endoscopy, and advanced adenoma indicates an adenoma >1 cm, villous histology, or high-grade dysplasia.

Table: Results of GI luminal evaluation in patients with low ferritin and normal hemoglobin levels.

Disclosures:

Yinglin Gao indicated no relevant financial relationships.

Sneha Shaha indicated no relevant financial relationships.

Kenneth Leung indicated no relevant financial relationships.

Eric Imbertson indicated no relevant financial relationships.

Muhammad Hammami indicated no relevant financial relationships.

Yinglin Gao, DO¹, Sneha Shaha, DO¹, Kenneth Leung, MD², Eric Imbertson, MD³, Muhammad B. Hammami, MD⁴. P2500 - High Yield of Relevant GI Endoscopic Findings in Patients With Unexplained Iron Deficiency Without Anemia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.