Endoscopic evaluation of iron deficiency without anemia: does it have the same benefit as in patients with anemia?

Background and Aim The need for endoscopic investigation in patients with iron deficiency without anemia (ID) is not established. Methods Data from patients with ID (serum ferritin ≤20 ng/mL, normal hemoglobin) studied with upper and lower endoscopy were retrospectively analyzed. Patients evaluated for iron deficiency anemia (IDA) served as controls, matched by sex and age in a proportion 2:1. Presence, type, location and age distribution of endoscopic findings were compared. Results 109 patients (55% females; mean age 59.6 ± 13.5 years; age distribution: <50 years 27.5%, 50–69 years 43.1%, ≥70 years 29.4%) were included in group ID and 218 matched controls in group IDA. Lesions were found in a similar proportion of patients (53.2% in group ID versus 49% in group IDA, p = 0.48) irrespective of age subgroup (<50 years 53.3% vs. 40%; 50–69 years 59.5% vs. 50%; ≥70 years 43.7% vs. 56.2%; p = 0.92). Diagnostic yield of colonoscopy in subgroup <50 years was low in both groups (6.3% vs. 4.2%, p = 0.76), and was significantly higher in group IDA in age subgroup 50–69 years (17.9% vs. 44.7%, p = 0.04). Multivariate analysis only revealed a significant relationship between age (OR: 1.04, CI 95% 1.02-1.06) and male sex (OR: 2.28, CI 95% 1.18-4.39) with a positive colonoscopy. Malignancy was significantly less frequent in group ID (1.8% vs. 14.2%, p <0.05). Conclusions Prevalence of gastrointestinal lesions in patients without anemia was similar to that of patients with anemia but malignancy was eight times less frequent. Systematic endoscopic evaluation in patients with ID is therefore questionable. Copyright © 2017 John Wiley & Sons, Ltd.