Detection of gastrointestinal lesions causing iron deficiency anemia by upper with or without lower GI endoscopy in the Egyptian society / Mohamed Mahmoud Ali Mahmoud ; Supervised Soheir Abdelfattah Aboelfadl , Diaa Eldeen Abdelaziz Mohamed

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Iron deficiency (ID) is defined as the decrease of the total content of iron in the body. Iron deficiency anemia (IDA) occurs when ID is sufficiently severe to reduce erythropoiesis. This type of anemia is the most frequent chronic anemia. ID may be the result of either excessive loss or, less frequently, decreased absorption (Goddard AF et al., 2011) in many cases, these alterations will be secondary to gastrointestinal disease. IDA occurs in 2%-5% of adult males and postmenopausal women in the developed world. ID, with or without anemia, is even more frequent. It is a common cause of consulting a gastroenterologist (4%-13% of all referred patients) (Sayer JM et al., 1993) Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID (McIntyre AS et al., 2012) It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, full laboratory tests for iron deficiency, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases (Beutler E et al., 2012) If both upper and lower endoscopies are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeated endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main technique in this case is enteroscopy (Yates JM et al., 2013)

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