Clinical Studies
Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient

https://doi.org/10.1016/S0002-9343(99)00162-XGet rights and content

Abstract

PURPOSE: Iron deficiency anemia is commonly caused by chronic gastrointestinal blood loss, and a thorough examination of the gastrointestinal tract has become standard practice. In contrast, iron deficiency without anemia has hardly been studied, and its causes are less certain. The aim of the present study was to determine the diagnostic value of upper and lower gastrointestinal evaluation in elderly hospitalized patients with iron deficiency, irrespective of the hemoglobin level.

PATIENTS AND METHODS: In a prospective study, 151 consecutive elderly patients with iron deficiency (serum ferritin level <50 μg/L at two separate occasions) were investigated using esophagogastroduodenoscopy with colonoscopy (n = 90) or barium enema (n = 61).

RESULTS: A potential upper gastrointestinal tract lesion was found in 47 (49%) of the 96 anemic patients and in 31 (56%) of the 55 nonanemic patients (P = 0.38). Nonanemic patients had a greater prevalence of erosive gastritis or duodenitis. Anemic patients (72%) were more frequently investigated with a colonoscopy than nonanemic patients (38%, P = 0.001), and a lower gastrointestinal lesion was found in 32% of the anemic patients and 16% of the nonanemic patients (P = 0.03). Cancer was the most common lesion in the colon; 11 of the 18 patients were asymptomatic. Site-specific symptoms, fecal occult blood loss, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) were not associated with the detection of gastrointestinal lesions. In 9.5% of the patients with a benign upper gastrointestinal lesion, a synchronous colonic tumor was found.

CONCLUSION: Elderly patients with iron deficiency should undergo endoscopic examination, irrespective of the hemoglobin level. The presence of gastrointestinal symptoms, a positive fecal occult blood test, and the use of NSAIDs are of limited value in guiding the diagnostic procedure.

Section snippets

Patients and methods

All patients older than 70 years with iron deficiency who were admitted to the acute geriatric ward during a 30-month study period were prospectively enrolled. None of these patients participated in our previous study (12). All patients were screened with a serum ferritin level at admission. Although the iron content of a bone marrow is the reference standard, a low serum ferritin level is a good indicator of depleted iron stores. There is no agreement on the lower limit of normal, but based on

Results

Of the 3,178 elderly patients who were admitted to the geriatric ward during the study period, 267 (8.4%) had two serum ferritin levels <50 μg/L and fulfilled the inclusion criteria. A gastrointestinal investigation was impractical in 19 patients because of poor general condition (terminal illness, coma) or because they died within the first days after admission. Of the remaining 248 patients who underwent an upper gastrointestinal endoscopy, 97 (39%) were subsequently excluded from the final

Discussion

The main aim of the present study was to investigate the prevalence of gastrointestinal lesions with a potential for bleeding in elderly patients admitted to a geriatric hospital. The patients were selected on the basis of a low serum ferritin level on admission. With few exceptions, previous studies that have addressed the efficacy of gastrointestinal investigation in patients with iron deficiency excluded patients who were not anemic 3, 4, 5, 6, 7, 8, 9, 10, 11, 14, 15. Our working hypothesis

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