Introduction Limited outcome data exists for patients with iron deficiency anaemia (IDA) investigated in accordance with the British Society of Gastroenterology (BSG) guidelines following normal gastrointestinal endoscopy.1 The importance of missed diagnoses in such patients is a key quality indicator for endoscopy services.2 The aim of this study was to evaluate long term outcomes for patients with IDA and normal upper and lower gastrointestinal endoscopy managed in accordance with BSG guidelines.1
Methods Review of a large consecutive series of adult patients referred for investigation of IDA from 1999–2006 to a UK district general hospital. All patients underwent successful oesophago-gastro-duodenoscopy (OGD) and colonoscopy. Those who received a definitive diagnosis were excluded (colorectal/upper gastrointestinal carcinoma, coeliac disease or inflammatory bowel disease). If endoscopic assessment found no cause for IDA no further investigations were undertaken aside from colonic adenoma surveillance. Case notes, laboratory, endoscopy and radiology records were reviewed to determine recurrence and re-investigation of IDA in these patients, any significant gastrointestinal pathology and patient outcomes. Survival was determined using the Kaplan-Meier technique.
Results 116 of 142 (82.3%) referred patients had no cause found for IDA on index endoscopic evaluations. Over a median follow up period of 12 years (153 months, range 108–192) there were 45 deaths in this cohort. 5- and 10 year survival rates were 91% and 74% respectively. 23 (19.8%) patients were re-referred for investigation of IDA of which 20 had further normal endoscopies. Overall 2 (1.7%) patients were diagnosed with gastrointestinal cancers during the period of follow up we reviewed. Neither could obviously be classified as a missed diagnosis; one oesophageal and one gastric cancer were diagnosed 12 years post index investigations. All endoscopies that patients subsequently underwent following index investigations were reviewed, including those for other indications and screening. In total 38 patients underwent endoscopy and one had a CT virtual colonoscopy. One patient was diagnosed with terminal ileal Crohn’s disease following re-referral with change in bowel habit 2 years after index investigations and one had haemorrhoids diagnosed on flexible sigmoidoscopy.
Conclusion Patients with IDA and normal upper and lower gastrointestinal endoscopies who were managed in accordance with BSG guidelines had acceptable long term outcomes. Overall this data supports the recommendations made by the BSG.
References 1 Goddard AF, et al. Gut 2011;60(10):1309–16.
2 Morris EJ, et al. Gut 2015;64(8):1248–56.
Disclosure of Interest None Declared