title: Endoscopic Evaluation of the Upper Gastrointestinal Tract is Worthwhile in Premenopausal Women with Iron-Deficiency Anaemia Irrespective of Menstrual Flow.
abstract: BACKGROUND
  In premenopausal women, iron-deficiency anaemia is common and menstrual flow is often held responsible, but it is not clear whether these women should be submitted to gastrointestinal (GI) evaluation. We aim to prospectively investigate whether premenopausal women with iron-deficiency anaemia benefit from GI evaluation regardless of menstrual flow.
  
  
  METHODS
  The study population comprised 59 consecutive premenopausal women with iron-deficiency anaemia. Excluded were women with obvious or suspected causes of anaemia and those ≤21 years. Heavy menstrual loss was not considered an exclusion criterion. All subjects had: complete blood count, ferritin, non-invasive testing by faecal occult blood (FOB),13C-urea breath test (13C-UBT), anti-tissue transglutaminase antibodies (tTG) and gastrin levels. Gastroscopy with antral (n = 3), corporal (n = 3) and duodenal (n = 2) biopsies was performed in women with positive13C-UBT or tTG titre or hypergastrinaemia.
  
  
  RESULTS
  Heavy menstrual loss was present in 50.8%. Non-invasive tests were positive in 40/59 (67.8%): 30 had positive13C-UBT, 12 had hypergastrinaemia, 7 had positive tTG and 3 had positive FOB. Women tested positive were similar to those tested negative as far as concerned age, haemoglobin and ferritin levels and heavy menstrual flow (55% versus 42.1%). All 40 women tested positive underwent gastroscopy with biopsies. Four (10%) had bleeding-associated lesions and 34 (85%) had non-bleeding-associated lesions. As regards upper GI findings, no differences were observed between women with normal and those with heavy menstrual flow. No lower GI tract lesions were detected in the three women with positive FOB.
  
  
  CONCLUSIONS
  Our data suggest that premenopausal women with iron-deficiency anaemia benefit from endoscopic evaluation of the upper GI tract irrespective of menstrual flow.
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: B
authors.initials: B
authors.lastname: Annibale
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: E
authors.initials: E
authors.lastname: Lahner
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: A
authors.initials: A
authors.lastname: Chistolini
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: C
authors.initials: C
authors.lastname: Gallucci
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: E
authors.initials: E
authors.lastname: Di Giulio
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: G
authors.initials: G
authors.lastname: Capurso
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: O
authors.initials: O
authors.lastname: Luana
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: B
authors.initials: B
authors.lastname: Monarca
authors.affiliation: a Digestive and Liver Disease Unit , 2nd Medical School, Policlinico Universitario Ospedale 'Sant' Andrea' , and Dept. of Haematology , University 'La Sapienza' , Rome , Italy.
authors.forename: G Delle
authors.initials: GD
authors.lastname: Fave
keywords: Coeliac disease; Helicobacter pylori; gastritis; iron deficiency anaemia; premenopausal women