[Iron deficiency: not always blood losses].
Iron deficiency may be the only presenting sign of malabsorption due to the presence of intestinal villous atrophy. Once gastrointestinal blood losses have been excluded, intestinal malabsorption should be investigated.


OBJECTIVE
To determine the utility of jejunal biopsy in the evaluation of iron deficiency due to a defective absorption and the different diseases that may cause malabsortive iron deficiency.


METHODS
Seventy patients with iron deficiency (ferritin<25 ng/ml), referred to the Unitat de Proves Funcionals Digestives to perform a jejunal biopsy were included. Jejunal biopsy was obtained distal to Treitz with a Watson capsule. Histological changes were classified according to the criteria proposed by Marsh.


RESULTS
Jejunal biopsy was performed in 66 patients. Histology was normal in 25, unespecific in 1, showed inflammatory infiltrate in 12, hyperplastic changes in 2 and atrophy in 25. In one patient showed intestinal giardiasis. The clinical diagnosis was celiac sprue in 21 patients (32%), aclorhydria in 7 (10.5%), bacterial overgrowth in 1 (1.5%), intestinal giardiasis in 1 (1.5%), menstrual blood loss in 1 (1.5%) and 35(53%) patients remained without a definitive diagnosis.


CONCLUSIONS
Jejunal biopsy is useful in the evaluation of iron deficiency due to intestinal malabsorption and reveals intestinal abnormalities in a significant number of cases.
Alonso Cotoner
C
C
Servei de Digestiu. Department d'Anatomia Patològica. Hospital Universitari Vall d' Hebrón. Barcelona, Spain.
Casellas Jordá
F
F
Chicharro Serrano
M L
ML
de Torres Ramírez
I
I
Malagelada Benaprés
J R
JR
D000126:Achlorhydria / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000747:Anemia, Hypochromic / Q000453:epidemiology / Q000209:etiology*; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007413:Intestinal Mucosa / Q000648:ultrastructure; D007501:Iron / Q000493:pharmacokinetics; D000090463:Iron Deficiencies; D007583:Jejunum / Q000473:pathology*; D008297:Male; D008871:Microvilli / Q000648:ultrastructure; D013030:Spain / Q000453:epidemiology
D005293:Ferritins; D007501:Iron