title: A comprehensive evaluation of the gastrointestinal tract in iron-deficiency anemia with predefined hemoglobin below 9mg/dL: A prospective cohort study.
abstract: BACKGROUND
  Anemia is defined as hemoglobin below the cutoff of normal in studies examining the gastrointestinal (GI) tract in iron-deficiency anemia (IDA). Although the risk of GI cancer (GIC) increases as hemoglobin decreases, guidelines do not usually recommend hemoglobin thresholds for IDA investigation.
  
  
  METHODS
  To elucidate whether underlying GI disorders explain the different hemoglobin values and clinical outcomes observed initially in IDA patients referred for GI workup, we prospectively investigated the diagnostic yield of a thorough GI examination in consecutive IDA adults with predefined hemoglobin <9g/dL and no extraintestinal bleeding.
  
  
  RESULTS
  4552 patients were enrolled over 10 years. 96% of 4038 GI lesions were consistent with occult bleeding disorders and 4% with non-bleeding disorders. Predominant bleeding disorders included upper GI ulcerative/erosive lesions (51%), GIC (15%), and angiodysplasias (12%). Diffuse angiodysplasias (45% of angiodysplasias) and GIC showed the lowest hemoglobin values (6.3 [1.5] and 6.4 [1.3]g/dL, respectively). While the spread (diffuse vs. localized) and number (<3 vs. ≥3) of angiodysplasias correlated with the degree of anemia, hemoglobin values were lower in GIC with vs. without ulcerated/friable lesions (6.0 [1.1] vs. 7.0 [1.2]g/dL, P<0.001).
  
  
  CONCLUSIONS
  Not only GIC but also diffuse angiodysplasias caused the most severe anemia in IDA with predefined hemoglobin values <9g/dL.
authors.affiliation: Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain. Electronic address: xavbosch@clinic.ub.es.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.affiliation: Quick Diagnosis Unit, Department of Internal Medicine, Hospital Plató, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Montori
authors.affiliation: Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Guerra-García
authors.affiliation: Primary Healthcare Center-CAPSE, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Costa-Rodríguez
authors.affiliation: Department of Internal Medicine, Hospital San Roque, Gonnet, La Plata, Argentina.
authors.forename: Mariano H
authors.initials: MH
authors.lastname: Quintanilla
authors.affiliation: Department of Internal Medicine, Hospital San Martín, La Plata, La Plata, Argentina.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Tolosa-Chapasian
authors.affiliation: Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.affiliation: Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Neus
authors.initials: N
authors.lastname: Guasch
authors.affiliation: Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Alfons
authors.initials: A
authors.lastname: López-Soto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000209:etiology; D016888:Angiodysplasia / Q000150:complications* / Q000175:diagnosis*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D041981:Gastrointestinal Tract / Q000473:pathology; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies; D013030:Spain
chemical_list: D006454:Hemoglobins
keywords: Diffuse angiodysplasias; Gastrointestinal cancer; Iron-deficiency anemia; Occult blood loss; Quick diagnosis units