[Iron deficiency anemia in hospitalized males and postmenopausal females. Diagnostic approach].
Chronic bleeding from the gastrointestinal tract is assumed to be the most common cause of iron deficiency anemia in men and in postmenopausal women.


OBJECTIVE
The aim of this study was to assess the most frequent causes of chronic gastrointestinal bleeding in patients with iron deficiency anemia and to suggest a diagnostic endoscopic strategy that could be useful in clinical practice.


METHODS
We studied 66 patients (48 women and 18 men), with a mean age of 73 who were admitted to our hospital from 1993 to 1996 because of unrelated signs and symptoms. Iron deficiency anemia was detected in a routine laboratory test. Patients had no symptoms of digestive disease. Children, pre-menopausal women and patients with a history of digestive disease of anemia of known origin were excluded. Diagnostic procedures included oral panendoscopy, colonoscopy and, in some cases, contrast radiology. In all patients follow-up was carried out between 3 and 36 months after discharge. Patients were considered to have improved when hemoglobin values were normal, according to standard laboratory values.


RESULTS
At least one lesion responsible for anemia was found in 46 patients (70%). Of these 46 patients, 31 presented a lesion in the upper digestive tract and 13 presented a lesion in the lower digestive tract. Colon cancer was diagnosed in eight patients and gastrointestinal cancer in one. In the remaining two patients, peptic ulcer and colo-rectal cancer were found simultaneously. A diagnosis of "minor" lesions was made in 15 patients (23%) and in five patients (7%) no lesions were found that could have caused the bleeding. Both groups (minor lesions and undiagnosed patients) improved with iron therapy.


CONCLUSIONS
Upper gastrointestinal lesions were the most frequent cause of iron-deficiency anemia, although colonoscopy is the best procedure for detecting gastrointestinal cancer and should be performed despite evident upper gastrointestinal bleeding.
Sánchez Martínez
F
F
Servicio de Medicina Interna, SCIAS, Hospital de Barcelona.
Vilà Santasuana
A
A
Cid Pañella
R
R
Gómez Vaquero
C
C
Ortega Enciso
L
L
Martínez Montauti
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies