Introduction Young males with iron deficiency (IDA) routinely undergo endoscopy. There is paucity of data on the diagnostic yield of bi-directional endoscopy, level of HB that requires investigation and the yield in symptomatic vs. asymptomatic young men.
We aim to study the diagnostic yield of bi-directional endoscopy in young males and the influence of gastrointestinal symptoms and HB level on yield.
Methods Data was collected from UNISOFT endoscopy software for all male patients referred for iron deficiency anaemia. Strict inclusion criteria were set and defined as: 1. Age 20–50 years 2. No prior gastrointestinal (GI) diagnosis 3. Blood indices - hypoferritinemia confirming IDA at the time of referral
A total of 36 patients were identified from January 2010 to July 2012. A retrospective review of blood parameters, symptoms, non-steroidal anti-inflammatory drug (NSAID) use, endoscopic findings and histologies were recorded. Data was recorded on an excel sheet and analysed using SPSS version 15.
Results A total of 36 patients were included in the study. The median age was 42 years. Eleven percent (n = 4) were referred from general medicine, 22% (n = 8) from general surgery and 67% (n = 24) from Gastroenterology for endoscopic investigations. Median HB level was 10g/dL. There were 4 patients on NSAIDs prior to referral.
Gastroscopy was performed in all patients and was normal in 94% (n = 34). The remaining 6% (n = 2) were diagnosed with h pylori gastritis (n = 1), and benign pyloric stenosis (n = 1). Duodenal (D2) biopsies were performed in 32 patients (89%), of which 1 patient was diagnosed with coeliac disease on histology. Three of the 4 patients with no D2 biopsies had a normal coeliac blood screen. Lower GI endoscopy (colonoscopy n = 30, flexible sigmoidoscopy n = 3) was performed in 33 (92%), of which 85% (n = 28/33) were macroscopically normal. Five patients had pathology encountered at endoscopy, these included adenomas (n = 3), ulcerative colitis (n = 1) and caecal carcinoma (n = 1).
Patients with IDA and no GI symptoms (n = 21); endoscopic diagnostic yield was 5% (n = 1) for gastroscopy and 11% (n = 2/19) for colonoscopy. The diagnostic yield in symptomatic patients was 7% (n = 1) for gastroscopy and 21% (n = 3/14) for colonoscopy.
There were 11 patients with IDA and an HB level over 11g/dL. All patients underwent gastroscopy with D2 biopsies and 10 patients underwent colonoscopy. All endoscopic investigations including D2 biopsies were normal.
Conclusion IDA in young males should always be investigated with bi-directional endoscopy, irrespective of symptoms. Although a small cohort, our study shows that the diagnostic yield is higher amongst patients with IDA and GI symptoms as well as IDA with an HB level below 11g/dL.
Disclosure of Interest None Declared.
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