title: Screening for gastrointestinal malignancy in patients with iron deficiency anemia by general practitioners: an observational study.
abstract: BACKGROUND
  The prevalence of iron deficiency anemia (IDA) is 2-5% in men and postmenopausal women in the developed world. IDA is commonly caused by chronic gastrointestinal blood loss, and a thorough examination of the gastrointestinal tract must be standard practice.
  
  
  OBJECTIVE
  To retrospectively study endoscopic evaluations of patients from general practitioners diagnosed with IDA in a peripheral hospital laboratory in order to determine the cause of IDA and the number of gastrointestinal malignancies.
  
  
  METHODS
  We retrospectively evaluated all patients with IDA diagnosed in a peripheral hospital laboratory by the general practitioner in the region of our hospital from 1 January 2004 until 31 December 2005. We included women older than 50 and men 18 years and older without a history of IDA in the previous 2 years.
  
  
  RESULTS
  In 2 years, 287 patients were newly diagnosed with IDA in our hospital laboratory. Only 90 (31%) patients were endoscopically evaluated within 4 months. Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 41 of 90 (46%) patients. The most common lesions identified by gastroduodenal endoscopy were erosive esophagitis, gastritis and duodenitis (14%). Cancer was the most commonly detected lesion in the colon, accounting for 17 of 21 colonic lesions explaining IDA. In total, gastrointestinal malignancy was diagnosed in 2% of screened patients. Factors determining the decision for endoscopic screening were lower hemoglobin level, lower ferritin level and male gender.
  
  
  CONCLUSIONS
  In our retrospective study of patients with IDA, only 31% received any form of endoscopic evaluation. In general practice, IDA is investigated suboptimally, and interventions other than the issuing of guidelines are needed to change practice.
authors: Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands. j.droogendijk@erasmusmc.nl
authors: Jolanda
authors: J
authors: Droogendijk
authors: Ruud
authors: R
authors: Beukers
authors: Paul B
authors: PB
authors: Berendes
authors: Martine G H M
authors: MG
authors: Tax
authors: Pieter
authors: P
authors: Sonneveld
authors: Mark-David
authors: MD
authors: Levin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis*; D004382:Duodenitis / Q000150:complications; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis*; D004941:Esophagitis / Q000150:complications; D005260:Female; D005756:Gastritis / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000209:etiology*; D019983:Guideline Adherence; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D006454:Hemoglobins