Endoscopy and iron deficiency anaemia—are small bowel biopsies enough?

▸ Kaye PV, Garsed K, Ragunath K, et al. The clinical utility and diagnostic yield of routine gastric biopsies in the investigation of iron deficiency anemia: a case-control study. Am J Gastroenterol 2008;103:2883–9.

Iron deficiency anaemia (IDA) is a common gastroenterology problem that often necessitates routine upper gastrointestinal endoscopy. Even if this is normal, British Society of Gastroenterology guidelines recommend small bowel biopsies to exclude coeliac disease. Helicobacter pylori infection has also been implicated in IDA, but there has been little focus on evaluating the presence of gastric atrophy, despite acid secretion being required for iron absorption. Kaye et al addressed this in a case–control study evaluating 161 patients having endoscopy for IDA and 169 retrospective controls that had gastric biopsies but did not have IDA. Five patients in the IDA group did not have gastric biopsies and gastric atrophy of the corpus was present in 40/156 (26%) of the IDA cases compared with 7/169 (5%) controls (p<0.001). H pylori infection was not associated with IDA in this study. Of the 35/156 patients who had a definite cause found for their IDA, only 3/35 (9%) had …