title: Long-term outcomes and prognostic factors for patients with endoscopy-negative iron deficiency.
abstract: OBJECTIVE
  Iron deficiency anemia (IDA) is a common problem among the elderly, and often no cause is identified after routine upper endoscopy and colonoscopy exams. The purpose of this study was to determine the long-term outcomes and predictors of gastrointestinal pathology and death in patients with endoscopy-negative IDA.
  
  
  METHODS
  This was a retrospective review of consecutive endoscopy negative-IDA patients during 2002-2004 at the VA San Diego Healthcare System.
  
  
  RESULTS
  Mean age was 69.3 years (range 42-93), and included 105 men and nine women. Mean length of follow-up was 65.1 months. IDA resolved in 56 patients. None of these patients developed evidence of any clinically significant gastrointestinal pathology. The remaining 58 patients had persistent anemia (n = 47) or recurrent anemia (n = 11). Only 2/47 patients with persistent anemia were found to have clinically significant but benign gastrointestinal pathology during follow-up. In contrast, 6/11 patients with recurrent anemia were subsequently found to have gastrointestinal pathology. Deaths during follow-up occurred in 7 (12.5 %) patients with resolved anemia, compared with 20 (34.5 %) patients with recurrent or persistent anemia (p = 0.006). Significant independent predictors of death included persistent or recurrent anemia, anti-platelet or anticoagulant use, and congestive heart failure.
  
  
  CONCLUSIONS
  Patients with iron deficiency anemia and negative upper endoscopy and colonoscopy often have a favorable outcome, especially if the anemia resolves with treatment. In patients with recurrent anemia a malignancy within reach of standard endoscopy and colonoscopy are possible, and repeating these procedures is warranted before consideration of further investigations.
authors.affiliation: Department of Medicine, Gastroenterology (111D), VA San Diego Healthcare System and University of California, San Diego, 3550 La Jolla Village Drive, San Diego, CA 92161, USA.
authors.forename: Anny
authors.initials: A
authors.lastname: Soon
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Cohen
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Groessl
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000401:mortality* / Q000473:pathology*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013995:Time; D041742:Upper Gastrointestinal Tract / Q000473:pathology