title: The usefulness of routine small bowel biopsies in evaluation of iron deficiency anemia.
abstract: BACKGROUND
  Iron deficiency anemia (IDA) may be the sole manifestation of celiac disease. The role of routine small bowel biopsies obtained during endoscopy in the evaluation of IDA is unclear. This study assessed the usefulness of routine small bowel biopsies in patients presenting with IDA.
  
  
  METHODS
  Evaluation of 103 consecutive patients with IDA undergoing panendoscopy with routine small bowel biopsies was performed. All patients had a diagnosis of IDA with either a ferritin less than 15 microg/L or iron saturation less than 8%. Celiac disease was defined as total or partial villous atrophy with intraepithelial lymphocytosis, histologically, and a clinical response to gluten free diet. Gastrointestinal symptoms were recorded.
  
  
  RESULTS
  Nine patients (8.7%) were diagnosed with celiac disease. Of these patients, endoscopic lesions potentially responsible for IDA were found in 33%. We found no statistically significant difference when comparing reports of diarrhea, weight loss, abdominal pain, nausea or vomiting, aspirin or NSAID use, or menopausal status with celiac disease status.
  
  
  CONCLUSIONS
  Routine small bowel biopsies to evaluate for celiac disease are indicated in the evaluation of patients with IDA. The finding of endoscopic lesions that may otherwise explain IDA should not preclude small bowel biopsy.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Grisolano
authors.forename: Amy S
authors.initials: AS
authors.lastname: Oxentenko
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Burgart
authors.forename: Ross A
authors.initials: RA
authors.lastname: Dierkhising
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology / Q000473:pathology*; D001706:Biopsy / Q000379:methods / Q000592:standards*; D002446:Celiac Disease / Q000150:complications / Q000473:pathology*; D020776:Endoscopes, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D041981:Gastrointestinal Tract / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies