Collaborative Research and Support of Fitzsimmons Army Medical Center Defense Women's Health Research Program Projects. Subtitle: Gastrointestinal Lesions in Iron Deficient Premenopausal Woman

摘要

The cause of iron deficiency anemia (IDA) in premenopausal women is often presumed to be due to menstrual losses. The purpose of this study was to investigate the diagnostic value of a comprehensive gynecologic and gastrointestinal evaluation among premenopausal women with IDA. Nineteen premenopausal non-pregnant women over 18 yrs of age with IDA defined by a HGB < 12 gm/dl with serum ferritin < 10 ng/ml participated in the study. Evaluations included: directed history and physical examination by a specialist in gynecology and gastroenterology, EGD, colonoscopy, UGI small bowel follow through, antiendomysial antibody test and fecal occult blood tests. Seven of 19 (37%) premenopausal women with IDA were diagnosed to have gynecologic cause of anemia by a specialist in that field. While only four of these seven patients has digestive complaints all but one (86%) were discovered to have gastrointestinal disease: DU, H pylori gastritis esophagitis and/or gastric AVM's. Of the 12 subjects without gynecologic source of anemia, GI evaluation each was identified to have significant GI disorders. Significant gastrointestinal disease is identifiable among most pre-menopausal women with IDA (18/19 or 95%), even when a careful evaluation by a specialist in gynecology suggests a gynecologic source. EGD should be considered in the evaluation of all premenopausal women with IDA and lower endoscopic examination should be reserved for those with suggestive symptoms or signs of colorectal disorders. Manuscript In Press, AM J. Gastro.