Michelle Likhtshteyn, MD1, Fray Martin M. Arroyo-Mercado, MD1, Jude Noel, MD1, Tanuj Chokshi, DO1, Nikita Gupta, DO1, Yasemin Aytaman, MD1, Aleksandr Khudyakov, MD1, Renata Lerer, MD1, Jennifer Grossman, MS1, Sabrina Tabone, MS1, David M. Frank, MD2, Manuel Martinez, MD, FACG2
1SUNY Downstate Medical Center, Brooklyn, NY; 2Brooklyn VA NY Harbor Healthcare System, Brooklyn, NY
Introduction: Iron Deficiency Anemia (IDA) occurs in 2-5% of adults and requires workup including upper esophagogastroduodenoscopy (EGD) and/or colonoscopy . However, in 10-41% of patients a source of bleeding is not identified [2-5], which requires investigation of the small bowel using video capsule endoscopy (VCE). This study aims to determine the long-term outcomes in patients with IDA and a pan endoscopy-negative IDA, which entails negative EGD, colonoscopy and VCE.
Methods: Medical records at the VA NY Harbor were queried for patients with IDA and having an EGD, colonoscopy, and VCE between 2005-2015. Anemia was defined as hemoglobin less than 13g/dL in men and 12g/dL in women; IDA was confirmed using serum ferritin less than 100 ng/mL. Exclusion criteria included underlying causes for IDA such as pre-menopausal women or history of ulcerative colitis. Biographical, laboratory and endoscopic data were obtained. Baseline hemoglobin and ferritin levels were recorded, and subsequently followed at 1, 3, and 6-year intervals.
Results: A total of 7,000 records were reviewed, 311 patients had EGD, colonoscopy and VCE; 67 of these patients were excluded. Of the remaining patients, 99 patients (13 females, 86 males) had a negative initial workup and were included in analysis. The mean age was 68.2 (± 11.1). IDA resolved in 37 (37.4%) patients, 49 (49.5%) patients had persistent anemia, and 13 (13.1%) patients had recurrent anemia. Of the 99 patients with negative workup, 80 (80.8%) patients went on to have subsequent EGD, colonoscopy or VCE. 62 (62.6%) patients had subsequent EGD with 12 (19.4%) patients having positive findings such as gastric ulcers. 64 (64.7%) patients had subsequent colonoscopies, 7 (10.9%) of these patients had positive findings such as chronically bleeding hemorrhoids. 18 (18.2%) patients had subsequent VCEs, and 5 (27.8%) of these patients had findings such as angioectasias.
Discussion: Our findings are consistent with previous reports suggesting that the majority of elderly patients who have an initial negative workup for IDA tend to have favorable outcomes. 21 of 80 patients (26.25%) had some findings on subsequent workup to explain IDA, however those findings were benign. In addition to previous published data, our study highlights the significance of VCE as a tool for identifying a bleeding source. Our study also emphasizes the need for randomized control studies to determine the optimal workup strategy for patients with initially negative bidirectional endoscopy and VCE.
Citation: Michelle Likhtshteyn, MD; Fray Martin M. Arroyo-Mercado, MD; Jude Noel, MD; Tanuj Chokshi, DO; Nikita Gupta, DO; Yasemin Aytaman, MD; Aleksandr Khudyakov, MD; Renata Lerer, MD; Jennifer Grossman, MS; Sabrina Tabone, MS; David M. Frank, MD; Manuel Martinez, MD, FACG. P1309 - OUTCOMES OF LONG-TERM FOLLOW-UP IN PATIENTS WITH IRON DEFICIENCY ANEMIA AND INITIAL NEGATIVE UPPER ENDOSCOPY, COLONOSCOPY, AND VIDEO CAPSULE ENDOSCOPY. Program No. P1309. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.