Gastrointestinal pathology in patients presenting with iron deficiency anaemia: A single-centre cross-sectional study

Shaik Mohammad Tahaseen; Ravi Kirti; Ramesh Kumar; Sanjay Pandey; Rajath Rao; Anjani Kumar; Rahul Arya; Tanmoy Maji; Ratnadeep Biswas

doi:10.4103/jfmpc.jfmpc_1150_24

Gastrointestinal pathology in patients presenting with iron deficiency anaemia: A single-centre cross-sectional study

J Family Med Prim Care. 2024 Nov;13(11):5341-5348. doi: 10.4103/jfmpc.jfmpc_1150_24. Epub 2024 Nov 18.

Authors

Shaik Mohammad Tahaseen¹, Ravi Kirti¹, Ramesh Kumar², Sanjay Pandey³, Rajath Rao⁴, Anjani Kumar¹, Rahul Arya², Tanmoy Maji², Ratnadeep Biswas¹

Affiliations

¹ Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India.
² Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India.
³ Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India.
⁴ Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka, India.

Abstract

Background: About a third of the world's population is estimated to suffer from anaemia, and iron deficiency is expected to account for about half of all anaemia cases. This study was designed to get an estimate of the proportion of patients with iron deficiency anaemia (IDA) who have a significant gastrointestinal (GI) pathology, in particular a GI malignancy, and to identify any risk factors or predictors for the same.

Methods: This cross-sectional study was conducted at a hospital in Eastern India. The study population comprised males above the age of 18 and postmenopausal females with IDA, excluding those haemodynamically unstable or with chronic diseases. Data collection included a detailed history, sociodemographic details, dietary habits, GI symptoms, and severity of anaemia. Faecal occult blood tests (OBTs) were conducted, and patients were referred for upper and lower GI endoscopy with biopsies.

Results: Out of the 257 patients, 50.97% (n = 131) had a significant GI pathology, and 25.68% (n = 66) had a GI malignancy. Male gender (AOR: 5.203, 95% CI: 1.725-15.698) and a positive stool OBT (AOR: 6.516, 95% CI: 2.255-18.828) were found to be independent risk factors for any GI pathology. Age 40 years or above (AOR: 11.376, 95% CI: 1.199-107.946), loss of appetite (AOR: 15.548, 95% CI: 1.416-170.735), pain abdomen (AOR: 5.566, 95% CI: 1.149-26.953), dysphagia (AOR: 7.945, 95% CI: 1.036-60.915), family history of malignancy (AOR: 46.726, 95% CI: 4.076-535.645), and positive OBT (AOR: 22.430, 95% CI: 3.933-127.915) were found to be independent risk factors of GI malignancy.

Conclusions: This study shows that a large proportion of adult males and postmenopausal females presenting with IDA in India have significant GI pathology. Furthermore, a significant proportion of them have GI malignancies. Thus, bidirectional endoscopy should be considered for these patients. Male patients, age >40, those with history of loss of appetite or weight, pain abdomen or dysphagia, positive family history, and positive OBT should be prioritised for the investigation.

Keywords: Anaemia; endoscopy; gastrointestinal; gastrointestinal diseases; gastrointestinal neoplasms; iron-deficiency; occult blood.