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Alshehri AA, Albahli OM, Alturki AM, Alwasaidi TA, Alfaris NF. Correlation of Anemia Due to Poor Iron Status With Obesity at King Fahad Medical City, Riyadh, Saudi Arabia. Cureus 2024; 16:e52424. [PMID: 38371105 PMCID: PMC10870246 DOI: 10.7759/cureus.52424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Background Saudi Arabia has a high prevalence of chronic diseases such as obesity. Moreover, iron deficiency anemia (IDA) in developing countries is the most prevalent type of anemia. This study aims to assess the correlation between anemia related to poor iron status and obesity. Methods A cross-sectional observational study was conducted at the obesity center in King Fahad Medical City, Saudi Arabia, from April to September 2020. Two hundred and forty participants were needed to be included in the study. The data was gathered by utilizing a designed data collection form. Socio-demographic data, weight and height, questions related to the history of anemia, and gynecological data (for females) were collected. The data was analyzed using SPSS (Statistical Package for Social Science) version 28.0. Descriptive statistics were used to present numerical and categorical data and a Chi-square test was conducted to assess the correlation between categorical variables. Informed written consent was obtained from all participants and ethical approval was obtained from the Ethical Board Committee in King Fahad Medical City. Results The study included 240 participants. Two-thirds of the study population are females (64.6%), 66.7% are married, and 65.8% have obesity. Almost one-half of the study population (46%, N=128) was diagnosed with IDA with malnourishment being the most common reason for IDA (88.2%). The results indicated a correlation between obesity and the prevalence of IDA. The prevalence of IDA among participants with obesity (60.4%) was significantly higher compared to non-obese participants (39.5%), p=0.002. The study found that females and underweight individuals have a higher prevalence of IDA (p<0.001). Conclusion Results of the present study suggest that obesity could be associated with a risk of IDA. In addition, Saudi women could be more prone to IDA than men. Further prospective controlled studies among diverse populations in Saudi Arabia including laboratory assessment of inflammatory markers and iron status are required to better understand the correlation between obesity and IDA.
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Affiliation(s)
- Ali A Alshehri
- Endocrinology and Metabolism, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, SAU
| | - Odai M Albahli
- Family Medicine, Saudi Board of Family Medicine, Kingdom of Saudi Arabia Ministry of Health, Riyadh, SAU
| | | | - Turki A Alwasaidi
- Internal Medicine, Prince Mohammed Bin Abdulaziz Hospital, Madinah, SAU
| | - Nasreen F Alfaris
- Obesity, Endocrine, and Metabolism, King Fahad Medical City, Riyadh, SAU
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McNally SA. Perioperative management of patients with anaemia: a new guideline. Br J Hosp Med (Lond) 2023; 84:1-4. [PMID: 36848164 DOI: 10.12968/hmed.2022.0552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Anaemia is common before major surgery and increases complications. A new guideline aims to help with early diagnosis of the type and cause of anaemia and initiate effective treatment. The guideline includes clear education for all staff and patients about the biology of iron homeostasis and patient blood management.
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Affiliation(s)
- Scarlett A McNally
- Department of Trauma and Orthopaedics, East Sussex Healthcare NHS Trust, Eastbourne, UK.,Centre for Perioperative Care, London, UK.,Brighton and Sussex Medical School, Brighton, UK
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Description of nurse practitioner functioning as most responsible provider in an intravenous therapy clinic. J Am Assoc Nurse Pract 2022; 34:1002-1007. [PMID: 35727193 DOI: 10.1097/jxx.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND IV antibiotic patients at the Strathcona Community Hospital were previously seen through the Strathcona emergency department (ED). This led to decreased patient satisfaction and increased wait times for these patients. PURPOSE The purpose of this study was to describe a nurse practitioner (NP) functioning as the most responsible provider (MRP) in an intravenous therapy (IVT) clinic and to describe the benefits and services the clinic provides within a suburban community hospital setting. METHODS Data were collected over a 5-year period from August 2015 to March 2019. Indicators included staff satisfaction, timely change in treatment modality, adherence to antimicrobial stewardship principles, appropriate triaging of IV iron referrals, and continuity of care. RESULTS Results included patients being seen in the IVT clinic rather than reassessment in the ED, which were 23,573; and patient length of stay, with average length of stay being 4.8-4.9 days for skin and soft tissue infections. Patient survey conducted in 2015 showed an 89% satisfaction rate. CONCLUSIONS Nurse practitioners functioning as MRP in an IVT clinic improve patient access to services, satisfaction, and provide appropriate medical care. IMPLICATIONS The success of this clinical model provides evidence to support an increased presence of NPs as MRPs. A better understanding of the financial breakdown of these clinics may provide additional insight into the full benefit of NP-led clinics on our health care system as a whole.
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No Danger for Medical Interest and Awareness towards Celiac Disease. Reply to Greenaway et al. Why Is There Medical Inertia and Nihilism to Celiac Disease? Comment on “Pivetta et al. In Elderly Anemic Patients without Endoscopic Signs of Bleeding Are Duodenal Biopsies Always Necessary to Rule Out Celiac Disease? Diagnostics 2022, 12, 678”. Diagnostics (Basel) 2022; 12:diagnostics12071511. [PMID: 35885417 PMCID: PMC9319639 DOI: 10.3390/diagnostics12071511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
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Pivetta G, Coluccio C, Dilaghi E, Lahner E, Pilozzi E, Carabotti M, Corleto VD. In Elderly Anemic Patients without Endoscopic Signs of Bleeding Are Duodenal Biopsies Always Necessary to Rule Out Celiac Disease? Diagnostics (Basel) 2022; 12:diagnostics12030678. [PMID: 35328233 PMCID: PMC8947612 DOI: 10.3390/diagnostics12030678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
Iron-deficiency anemia in the elderly may be due to numerous gastrointestinal conditions. Anemia is frequent in celiac disease (CD); however, the use of routine duodenal biopsies, independently of age or serology, is debated. To determine the diagnostic yield of routine duodenal biopsies in adult and elderly patients with no bleeding anemia, a cross-sectional study analyzing 7968 gastroscopies (2017−2020) was performed; 744 were for anemia and 275 were excluded (GI bleeding or without duodenal biopsies). Of the 469 included patients, clinical, endoscopic, and histological features were analyzed in groups with or without histopathological changes in the duodenal mucosa (DM). Univariate/multivariate analyses were performed. Of the 469 patients, 41 (8.7%) had DM histopathological changes, 12 (2.6%) had CD, 26 (5.5%) had duodenal intraepithelial lymphocytosis (DIL), and 3 had (0.6%) other conditions. They were younger compared to patients with normal DM. DM histopathology was significantly inversely correlated with age group, with prevalences of 27%, 20%, 12.5%, 10%, and 2.5%, in the <40−50, 51−60, 61−70, 71−80, and >80-year age groups, respectively (p = 0.0010). Logistic-regression models showed that anemic patients aged >60, >70, or >80 years with endoscopically normal DM had a progressively three- to four-fold higher probability of having normal duodenal histology. In adults, anemic patients without bleeding, age and endoscopically normal DM are predictors of normal DM histology. In >70-year anemic patients, negligible DM pathology was found. The results suggest that routine duodenal biopsies are questionable in elderly anemic patients
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Affiliation(s)
- Giulia Pivetta
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
| | - Chiara Coluccio
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
| | - Emanuele Dilaghi
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
| | - Edith Lahner
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
| | - Emanuela Pilozzi
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza, 00166 Rome, Italy
| | - Marilia Carabotti
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
| | - Vito Domenico Corleto
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
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Calim A, Kanat E, Mazi EE, Oygen S, Karabay U, Borlu F. Evaluation of In-patients with Iron Deficiency Anemia in terms of Etiology. SISLI ETFAL HASTANESI TIP BULTENI 2020; 54:428-432. [PMID: 33364882 PMCID: PMC7751250 DOI: 10.14744/semb.2018.47354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, we aimed to evaluate in-patients with iron deficiency anemia concerning etiology. METHODS In our study, we retrospectively evaluated 150 in-patients (60 male and 90 female) with iron deficiency anemia in Sisli Etfal Hospital, Department of Internal Diseases between 2005 and 2010. Anemia was defined as Hb <12 g/dl for women and <13 g/dl for men and transferrin saturation ≤15%. RESULTS In our study, 60 male and 90 female patients were included. Analyzing the etiology of iron deficiency anemia in 150 patients, we identified erosive gastritis in 35 (23.3%) patients, gastric cancer in 15 (10%) patients, colon polyps in 14 (9.3%) patients, erosive gastritis in 14 (9.3%) patients, myoma in 14 (9.3%) patients, diverticulosis in 13 (8.6%) patients, colon cancer in seven (4.6%) patients, menometrorrhagia in seven (4.6%) patients, malabsorption in six (4%) patients, hemorrhoids in six (4%) patients, celiac disease in four (2.6%) patients, bladder cancer in three (2%) patients, hematologic malignancy in three (2%) and other diseases (unexplained etiology) in 23 (15.3%) patients. CONCLUSION When iron deficiency anemia is detected, it may be a warning of an underlying severe illness. Reasons for many cases arise from upper and lower gastrointestinal tract diseases. Endoscopic examinations are important for diagnosis. We suggest performing gastroscopy and colonoscopy together in patients with iron deficiency anemia.
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Affiliation(s)
- Aslihan Calim
- Department of Internal Disease, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Evren Kanat
- Department of Internal Disease, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Emrah Erkan Mazi
- Department of Rheumatology, Hatay State Hospital, Istanbul, Turkey
| | - Suayp Oygen
- Department of Internal Disease, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Umut Karabay
- Department of Internal Disease, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Fatih Borlu
- Department of Internal Disease, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
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Teshome MS, Meskel DH, Wondafrash B. Determinants of Anemia Among Pregnant Women Attending Antenatal Care Clinic at Public Health Facilities in Kacha Birra District, Southern Ethiopia. J Multidiscip Healthc 2020; 13:1007-1015. [PMID: 33061406 PMCID: PMC7522419 DOI: 10.2147/jmdh.s259882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anemia is accountable for 20% of maternal death globally, and it is associated with premature birth, low birth weight, and infant death. According to the WHO report of 2008, 57.1% of pregnant women were anemic in Africa. In Ethiopia, anemia among pregnant women is 62.7%. There were no data in the study area that identified the determinants of anemia. OBJECTIVE To identify the determinants of anemia among pregnant mothers attending ANC clinic in public health facilities in Kacha Birra District, Southern Ethiopia. METHODS An institutional-based unmatched case-control study was conducted among pregnant women attending antenatal care clinics in public health facilities in Kacha Birra District, Southern Ethiopia, from February 1/2019-May 30/2019. An aggregate of 117 cases and 227 controls were involved in the study. Data were collected using interviewer-administered questionnaires. Controls were pregnant ladies whose blood hemoglobin level was 11 g/dl and above at their first antenatal care clinic, and cases were pregnant ladies whose hemoglobin level less than 11 g/dl. Both bivariate and multivariable logistic regression models were used to isolate independent predictors of anemia. RESULTS An overall of 344 respondents (117 cases and 227controls) were included in this study with a response rate of 100%. On multivariable logistic regression models, significant predictors of anemia were: rural residence [AOR= 2.9,95% CI:1.18-5.84], previous history of heavy menstrual blood flow [AOR=2.75, 95% CI: 2.66-28.53], age of mother [AOR=4.013, 95% CI: 1.08-14.90], parasitic infection [AOR=6.39, 95% CI: 1.226-33.362], food taboo (aversion) [AOR= 3.92, CI: 95% 2.08-7.35], drinking tea/coffee instantly after meal [AOR=18.49, 95% CI:6.89-40.64]. CONCLUSION Residence, previous heavy menstrual flow, age, parasitic infection, food taboo, and tea/coffee consumption immediately after meals were significant predictors of anemia among pregnant women. So, anemia prevention and control policy should include the promotion of counseling on the consumption of diversified and iron-enriched foods during pregnancy, prevention of parasitic infection as well as mass deworming, awareness creation on cultural norms that makes food aversion during pregnancy.
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Affiliation(s)
- Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Desalech H Meskel
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Beyene Wondafrash
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
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Kumar A, Gupta S, Meena LP, Meher MP, Rai M, Kumar S, Bharti A. Study to evaluate the etiology of iron deficiency anemia at a teaching hospital in northeastern part of India. J Family Med Prim Care 2020; 9:3076-3081. [PMID: 32984176 PMCID: PMC7491828 DOI: 10.4103/jfmpc.jfmpc_3_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction The causes of iron deficiency may be either due to excessive loss or, less frequently, decrease absorption. Data related to etiology are not available from this part of the country. Objective A study to evaluate the etiology of iron-deficiency anemia at a teaching hospital in the northeastern part of India. Materials and Methods In this cross-sectional study, cases of iron-deficiency anemia were selected from the OPD and indoor, after taking proper written consent. Iron-deficiency anemia was diagnosed by sending the complete hematological investigations. Other specific investigations including imaging were done in selected patients as per indications. Results A total of 102 patients of iron-deficiency anemia were included in the study. The age of the selected population was between 18 and 80 years. 37.3% were male and 62.7% were female patients. Upper gastrointestinal endoscopy was done in 56, out of these, 9.7% had antral gastritis and 2.9% had a duodenal ulcer. Lower gastrointestinal endoscopy was done in 30 patients and out of these seven patients had hemorrhoids, one patient had multiple ulcers in the colon, one had ulcers in the sigmoid colon, and one had ulceroproliferative mass in the transverse colon. Biopsy through the upper gastrointestinal endoscopy showed chronic duodenitis in three patients (2.9%), carcinoma stomach in one (0.98%), and periampullary carcinoma in one (0.98%). Biopsy after lower gastrointestinal endoscopy showed one case each of carcinoma colon, ulcerative colitis, nonspecific colitis, and nonspecific enteritis. Conclusion Diagnosis of iron-deficiency anemia is not sufficient without the diagnosis of underlying etiology. Special concern will be taken to gastrointestinal malignancies like colorectal cancers in which iron-deficiency anemia may be the only manifestation and diagnosis that can be missed if we do not investigate properly.
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Affiliation(s)
- Abhishek Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Saumya Gupta
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lalit P Meena
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mukti P Meher
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Madhukar Rai
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anju Bharti
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Arabi SM, Ranjbar G, Bahrami LS, Vafa M, Norouzy A. The effect of vitamin D supplementation on hemoglobin concentration: a systematic review and meta-analysis. Nutr J 2020; 19:11. [PMID: 32013954 PMCID: PMC6998164 DOI: 10.1186/s12937-020-0526-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS The purpose of this review was to investigate the effect of vitamin D supplements on hemoglobin concentration in subjects aged 17.5-68 years old; using randomized controlled trials (RCTs). METHODS Relevant RCT studies were identified from January 2000 to January 2019 by using MeSH terms in PubMed, Embase, Cochrane Library, Clinical trials, Scopus databases and gray literature. The studies were reviewed systematically, and quality assessments were evaluated by the guidelines of the Cochrane risk of bias. The effect of vitamin D supplements (n = 14) on hemoglobin concentration was considered as primary outcome, while its effects on the levels of ferritin, transferrin saturation and iron status were derived as secondary outcomes. In total, 1385 subjects with age range of 17.5 to 68 years old were examined for 3 h to 6 months; Mean (standard deviation) or median interquartile changes in the hemoglobin concentration in each treatment group was recorded for meta-analysis. RESULTS Fourteen RCTs met the inclusion criteria. Current study findings propose that vitamin D supplementation leads to a non-significant reduction in hemoglobin levels in subjects (17.5-68 years old) [std. mean difference (SMD): 0.01; 95% CI: - 0.28, 0.29; P = 0.95], also it has no significant effect on ferritin concentrations [std. mean difference (SMD): -0.01; 95% CI: [- 0.20, 0.18; P = 0.91]. However, vitamin D supplementation demonstrated positive effects on transferrin saturation [mean difference (MD): 1.54; 95% CI: 0.31, 2.76; P = 0.01] and iron status [std. mean difference (SMD): 0.24; 95% CI: - 0.09, 0.39; P = 0.002]. CONCLUSION Current review concluded that supplementation with vitamin D had no significant effect on hemoglobin and ferritin levels while positive effects on transferrin saturation and iron status were observed. Further clinical studies are required to determine the actual effect of this intervention on hemoglobin levels.
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Affiliation(s)
- Seyed Mostafa Arabi
- Metabolic Syndrome Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91179481564 Iran
| | - Golnaz Ranjbar
- Metabolic Syndrome Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91179481564 Iran
| | - Leila Sadat Bahrami
- Metabolic Syndrome Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91179481564 Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Norouzy
- Metabolic Syndrome Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91179481564 Iran
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Burnett-Hartman AN, Kamineni A, Corley DA, Singal AG, Halm EA, Rutter CM, Chubak J, Lee JK, Doubeni CA, Inadomi JM, Doria-Rose VP, Zheng Y. Colonoscopy Indication Algorithm Performance Across Diverse Health Care Systems in the PROSPR Consortium. EGEMS (WASHINGTON, DC) 2019; 7:37. [PMID: 31531383 PMCID: PMC6676916 DOI: 10.5334/egems.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 06/21/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the importance of characterizing colonoscopy indication for quality monitoring and cancer screening program evaluation, there is no standard approach to documenting colonoscopy indication in medical records. METHODS We applied two algorithms in three health care systems to assign colonoscopy indication to persons 50-89 years old who received a colonoscopy during 2010-2013. Both algorithms used standard procedure, diagnostic, and laboratory codes. One algorithm, the KPNC algorithm, used a hierarchical approach to classify exam indication into: diagnostic, surveillance, or screening; whereas the other, the SEARCH algorithm, used a logistic regression-based algorithm to provide the probability that colonoscopy was performed for screening. Gold standard assessment of indication was from medical records abstraction. RESULTS There were 1,796 colonoscopy exams included in analyses; age and racial/ethnic distributions of participants differed across health care systems. The KPNC algorithm's sensitivities and specificities for screening indication ranged from 0.78-0.82 and 0.78-0.91, respectively; sensitivities and specificities for diagnostic indication ranged from 0.78-0.89 and 0.74-0.82, respectively. The KPNC algorithm had poor sensitivities (ranging from 0.11-0.67) and high specificities for surveillance exams. The Area Under the Curve (AUC) of the SEARCH algorithm for screening indication ranged from 0.76-0.84 across health care systems. For screening indication, the KPNC algorithm obtained higher specificities than the SEARCH algorithm at the same sensitivity. CONCLUSION Despite standardized implementation of these indication algorithms across three health care systems, the capture of colonoscopy indication data was imperfect. Thus, we recommend that standard, systematic documentation of colonoscopy indication should be added to medical records to ensure efficient and accurate data capture.
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Affiliation(s)
- Andrea N. Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, US
- Fred Hutchinson Cancer Research Center, Seattle, WA, US
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Ethan A. Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, US
| | | | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Chyke A. Doubeni
- Center for Health Equity and Community Engagement Research, Rochester, MN, US
- Department of Family Medicine, Mayo Clinic, Rochester, MN, US
| | - John M. Inadomi
- Division of Gastroenterology, University of Washington, School of Medicine, Seattle, WA, US
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, US
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, US
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Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review. ACTA ACUST UNITED AC 2019; 55:medicina55070337. [PMID: 31277328 PMCID: PMC6681258 DOI: 10.3390/medicina55070337] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Background and objective: Often micronutrient deficiencies cannot be detected when patient is already following a long-term gluten-free diet with good compliance (LTGFDWGC). The aim of this narrative review is to evaluate the most recent literature that considers blood micronutrient deficiencies in LTGFDWGC subjects, in order to prepare dietary supplementation advice (DSA). Materials and methods: A research strategy was planned on PubMed by defining the following keywords: celiac disease, vitamin B12, iron, folic acid, and vitamin D. Results: This review included 73 studies. The few studies on micronutrient circulating levels in long-term gluten-free diet (LTGFD) patients over 2 years with good compliance demonstrated that deficiency was detected in up to: 30% of subjects for vitamin B12 (DSA: 1000 mcg/day until level is normal, then 500 mcg), 40% for iron (325 mg/day), 20% for folic acid (1 mg/day for 3 months, followed by 400–800 mcg/day), 25% for vitamin D (1000 UI/day or more-based serum level or 50,000 UI/week if level is <20 ng/mL), 40% for zinc (25–40 mg/day), 3.6% of children for calcium (1000–1500 mg/day), 20% for magnesium (200–300 mg/day); no data is available in adults for magnesium. Conclusions: If integration with diet is not enough, starting with supplements may be the correct way, after evaluating the initial blood level to determine the right dosage of supplementation.
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Arasaradnam RP, Brown S, Forbes A, Fox MR, Hungin P, Kelman L, Major G, O'Connor M, Sanders DS, Sinha R, Smith SC, Thomas P, Walters JRF. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67:1380-1399. [PMID: 29653941 PMCID: PMC6204957 DOI: 10.1136/gutjnl-2017-315909] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 02/07/2023]
Abstract
Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.
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Affiliation(s)
- Ramesh P Arasaradnam
- University Hospital Coventry, Coventry, UK
- Department of Applied Biological Sciences, University of Coventry, Coventry, UK
- Clinical Sciences Research Institute, University of Warwick, Warwick, UK
| | | | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mark R Fox
- University of Zürich, Zürich, Switzerland
- Abdominal Centre, St Claraspital, Basel, Switzerland
| | - Pali Hungin
- School of Medicine, Pharmacy & Health, University of Durham, Durham, UK
| | | | - Giles Major
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | | | - Rakesh Sinha
- Department of Radiology, South Warwickshire Hospitals, Warwick, UK
| | - Stephen Charles Smith
- Department of Clinical Biochemistry, Midlands and NW Bowel Cancer Screening Hub, Rugby, UK
| | - Paul Thomas
- Department of Gastroenterology, Musgrave Park Hospital, Taunton, UK
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Olano C, Pazos X, Avendaño K, Calleri A, Ketzoian C. Diagnostic yield and predictive factors of findings in small-bowel capsule endoscopy in the setting of iron-deficiency anemia. Endosc Int Open 2018; 6:E688-E693. [PMID: 29868633 PMCID: PMC5979215 DOI: 10.1055/a-0593-5915] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/20/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Despite the widespread use of small-bowel capsule endoscopy (CE), there is still limited data on its utility and effectiveness for the diagnosis and management of patients with iron-deficiency anemia (IDA). AIM To assess the diagnostic yield of CE and the factors predicting positive findings in patients with IDA. METHODS Patients with unexplained IDA and negative upper and lower endoscopy were included. A positive diagnostic yield was considered when CE diagnosed one or more lesions that could explain the IDA. Sex, age, NSAID consumption, blood transfusion requirement, and ferritin and hemoglobin levels were recorded. RESULTS In total, 120 CE were included (mean age 58.5 years; F/M 82:38). Mean hemoglobin levels were 9 g/dL and mean ferritin levels were 15.7 ng/mL. Positive findings were present in 50 % of patients. The most frequent was angiodysplasia (45 %). Despite several baseline variables being significantly associated with positive findings, using a logistic regression model, it was verified that male sex (OR 3.93; 95 %CI 1.57 - 9.86), age (OR 1.03; 95 %CI 1.00 - 1.06), and hemoglobin levels (OR 0.73; 95 %CI 0.57 - 0.94) were the variables having an independent effect on the probability of obtaining positive findings. Age older than 50 years (OR 14.05; 95 %CI 1.69 - 116.23) and male sex (OR 3.63; 95 %CI 1.29 - 10.17) were the variables which increased the risk of diagnosing angiodysplasia. CONCLUSIONS CE is a useful technique in patients with IDA. To improve its yield, it is necessary to select patients carefully. Male sex, older age, and low hemoglobin levels were associated with a risk of positive finding in this group of patients. The risk of diagnosing angiodysplasia increased with male sex and older age.
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Affiliation(s)
- Carolina Olano
- Clinica de Gastroenterología “Prof. Henry Cohen”, Hospital de Clínicas, UDELAR, Montevideo, Uruguay,Corresponding author Carolina Olano, MD MSc Hospital de ClinicasAv. Italia s/n CP 11600MontevideoUruguay+598-2-4872572
| | - Ximena Pazos
- Clinica de Gastroenterología “Prof. Henry Cohen”, Hospital de Clínicas, UDELAR, Montevideo, Uruguay
| | - Karla Avendaño
- Clinica de Gastroenterología “Prof. Henry Cohen”, Hospital de Clínicas, UDELAR, Montevideo, Uruguay
| | - Alfonso Calleri
- Clinica de Gastroenterología “Prof. Henry Cohen”, Hospital de Clínicas, UDELAR, Montevideo, Uruguay
| | - Carlos Ketzoian
- Clinica de Gastroenterología “Prof. Henry Cohen”, Hospital de Clínicas, UDELAR, Montevideo, Uruguay
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Brim H, Shahnazi A, Nouraie M, Badurdeen D, Laiyemo AO, Haidary T, Afsari A, Ashktorab H. Gastrointestinal Lesions in African American Patients With Iron Deficiency Anemia. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2018; 11:1179552218778627. [PMID: 29795991 PMCID: PMC5960842 DOI: 10.1177/1179552218778627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/30/2017] [Indexed: 12/14/2022]
Abstract
Background: Iron deficiency anemia (IDA) is a frequent disorder that is associated with many serious diseases. However, the findings of an evaluation of IDA-associated gastrointestinal disorders are lacking among African American patients. Aim: To determine the most prevalent gastrointestinal lesions among African American patients with IDA especially in young men. Methods: We reviewed medical records (n = 422) of patients referred for evaluation of IDA from 2008 to 2012. Iron deficiency anemia was diagnosed using clinical laboratory tests. The results of esophagogastroduodenoscopy, colonoscopy, and pathology specimens along with demographic data were abstracted and analyzed using Stata. Results: The mean age was 61.9 years, and 50.5% were women. In total, 189 patients (45%) had gross gastrointestinal (GI) bleeding. The most frequent diagnoses were gastritis (40%), benign colonic lesions (13%), esophagitis (9%), gastric ulcer (6%), and duodenitis (6%). GI bleeding was significantly more frequent in men (P = 0.001). Benign and malignant colonic lesions were significantly more present among older patients: 16% vs 6% (P = .005) and 5% vs 0% (P = .008), respectively. Colitis was more prevalent in younger patients (⩽50): 11% vs 2% (P = .001). In patients with gross lower GI bleeding, the top diagnoses were gastritis (25%), benign colon tumors (10%), and duodenitis (6%). Colon cancer was diagnosed among 15 patients, and all these patients were older than 50 years of age. Conclusions: Gastritis and colonic lesions are most common associated lesions with IDA among African Americans. So bidirectional endoscopy is required for unrevealing of the cause of IDA in asymptomatic patients.
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Affiliation(s)
- Hassan Brim
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Anahita Shahnazi
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh, PA, USA
| | - Dilhana Badurdeen
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Adeyinka O Laiyemo
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Tahmineh Haidary
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Ali Afsari
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Hassan Ashktorab
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC, USA
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15
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Banerjee AK, Celentano V, Khan J, Longcroft-Wheaton G, Quine A, Bhandari P. Practical gastrointestinal investigation of iron deficiency anaemia. Expert Rev Gastroenterol Hepatol 2018; 12:249-256. [PMID: 29129158 DOI: 10.1080/17474124.2018.1404905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
About 10% of oesophagogastroduodenoscopies (OGDs) and colonoscopies are done for investigation of iron deficiency anemia (IDA) . Much of the existing guidance on investigation of IDA predates CRC screening, which has driven significant improvements in colonoscopy quality and completion rates, as well as a reduction in Helicobacter pylori prevalence and increase in PPI usage, and therefore probably needs re-consideration. New investigations, e.g. CT colonography, enteroscopy and capsule endoscopy have also been introduced. Areas covered: This review updates the approach to practical investigation of IDA. Medline was searched using the terms iron deficiency AND anemia AND/OR gastroscopy, colonoscopy, capsule and enteroscopy, together with review of recent relevant published abstracts on the topic. Expert commentary: Gastrointestinal pathology is now a more common cause of IDA than upper GI causes, reflecting better colonoscopy accuracy and completion rates as well as changing disease patterns, and carcinomas are more likely cause IDA than benign adenomas. Increasing use of antiplatelet and anticoagulants is driving greater presentation of IDA. Capsule endoscopy, enteroscopy and CT colonography are increasingly used. Fecal occult blood testing may be a useful simple screening method in the frail, as a negative test can avoid the need for invasive tests.
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Affiliation(s)
- Anjan K Banerjee
- a Department of Colorectal Surgery , Queen Alexandra Hospital Portsmouth , Portsmouth , UK.,b Care UK North East London Treatment Centre , Ilford , UK
| | - Valerio Celentano
- a Department of Colorectal Surgery , Queen Alexandra Hospital Portsmouth , Portsmouth , UK
| | - Jim Khan
- a Department of Colorectal Surgery , Queen Alexandra Hospital Portsmouth , Portsmouth , UK
| | - Gaius Longcroft-Wheaton
- c Department of Gastroenterology , Queen Alexandra Hospital Portsmouth , Portsmouth , UK.,d University of Portsmouth , Portsmouth , UK
| | - Amanda Quine
- c Department of Gastroenterology , Queen Alexandra Hospital Portsmouth , Portsmouth , UK
| | - Pradeep Bhandari
- c Department of Gastroenterology , Queen Alexandra Hospital Portsmouth , Portsmouth , UK.,d University of Portsmouth , Portsmouth , UK
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16
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Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost-efective and should be replaced with universally performed pre-endoscopy serology in patients on a suspected cancer pathway. Tech Coloproctol 2018; 22:121-124. [PMID: 29476446 PMCID: PMC5846821 DOI: 10.1007/s10151-018-1756-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron deficiency anaemia remains a common procedure, but is expensive and time-consuming. Serological investigation for coeliac disease is also recommended, having excellent accuracy with the added benefit of lower cost. This study sought to examine the utility of duodenal biopsy and coeliac serology in the diagnosis of coeliac disease. METHODS A prospectively maintained database was interrogated to identify all patients having upper gastrointestinal endoscopy for the investigation of anaemia between January 01, 2016, and December 31, 2016. RESULTS Of the 1131 patients having an endoscopy, coeliac serology was measured in only 412 (36%) and was positive in 9 cases (2%), leading to 6 histological diagnoses of coeliac disease and 3 false positives. Two-hundred and seventy-four patients with negative serology had biopsies taken which were all negative. Only 2/451 (0.4%) patients who had biopsies performed in the absence of a serology test were histologically positive for coeliac disease. The cost per diagnosis of a case of coeliac disease in those with either negative or absent coeliac serology was £18,839 (US$25,244, €21,196). CONCLUSIONS Random duodenal biopsy is not a cost-effective method of diagnosing coeliac disease and should be replaced with pre-endoscopy coeliac serology.
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17
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Nielsen OH, Soendergaard C, Vikner ME, Weiss G. Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease. Nutrients 2018; 10:nu10010082. [PMID: 29342861 PMCID: PMC5793310 DOI: 10.3390/nu10010082] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 02/06/2023] Open
Abstract
Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD.
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Affiliation(s)
- Ole Haagen Nielsen
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark.
| | - Christoffer Soendergaard
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark.
| | - Malene Elbaek Vikner
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark.
| | - Günter Weiss
- Department of Internal Medicine II, Medical University Hospital of Innsbruck, Innsbruck, A-6020, Austria.
- Christian Doppler Laboratory for Iron Metabolism and Anemia Research, University of Innsbruck, Innsbruck, A-6020, Austria..
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18
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Clere-Jehl R, Schaeffer M, Vogel T, Kiesmann M, Pasquali JL, Andres E, Bourgarit A, Goichot B. Upper and lower gastrointestinal endoscopies in patients over 85 years of age: Risk-benefit evaluation of a longitudinal cohort. Medicine (Baltimore) 2017; 96:e8439. [PMID: 29095285 PMCID: PMC5682804 DOI: 10.1097/md.0000000000008439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
After age 85, upper and lower gastrointestinal (GI) endoscopy may be indicated in 5% to 10% of inpatients, but the risk-benefit ratio is unknown. We studied patients older than 85 years undergoing upper and lower GI endoscopy.We analyzed a retrospective cohort of inpatients older than 85 years between 2004 and 2012, all explored by upper and complete lower GI endoscopy. Initial indications, including iron deficiency anemia (IDA), other anemias, GI bleeding, weight loss, and GI symptoms, were noted, as were endoscopy or anesthesia complications, immediate endoscopic diagnosis, and the ability to modify the patients' therapeutics. Deaths and final diagnosis for initial endoscopic indication were analyzed after at least 12 months.We included 55 patients, 78% women, with a median age, reticulocyte count, hemoglobin, and ferritin levels of 87 (85-99), 56 (24-214) g/L, 8.6 (4.8-12.9) g/dL, and 56 (3-799) μg/L, respectively. IDA was the most frequent indication for endoscopy (60%; n = 33). Immediate diagnoses were found in 64% of the patients (n = 35), including 25% with GI cancers (n = 14) and 22% with gastroduodenal ulcers or erosions (n = 12). Cancer diagnosis was associated with lower reticulocyte count (45 vs. 60 G/L; P = .02). Among the 35 diagnoses, 94% (n = 33) led to modifications of the patients' therapeutics, with 29% of the patients deciding on palliative care (n = 10). No endoscopic complications lead to death. Follow-up of >12 months was available in 82% (n = 45) of the patients; among these patients, 40% (n = 27) died after an average 24 ± 18 months. Cancer diagnosis was significantly associated with less ulterior red cell transfusion (0% vs. 28%; P = .02) and fewer further investigations (6.7% vs. 40%; P = .02).Upper and complete lower GI endoscopy in patients older than 85 years appears to be safe, and enables a high rate of immediate diagnosis, with significant modifications of therapeutics. GI cancers represented more than one-third of the endoscopic diagnoses.
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Affiliation(s)
- Raphaël Clere-Jehl
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
| | | | | | | | | | - Emmanuel Andres
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Bourgarit
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Goichot
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
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19
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Kawasaki K, Hamamoto Y, Horibe M, Shimura K, Nakamura A, Kanai T, Takaishi H. Curative resectability of gastrointestinal cancer identified from iron deficiency anemia. Oncol Lett 2017; 14:4301-4304. [PMID: 28943943 DOI: 10.3892/ol.2017.6650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/17/2017] [Indexed: 01/22/2023] Open
Abstract
The present study aimed to clarify the staging and curative resectability of gastrointestinal cancer found through iron deficiency anemia (IDA). An electronic database was used and females >51 and males >18 years old were identified who had been diagnosed with IDA at the internal medicine outpatient clinic of Asahi General Hospital (Chiba, Japan) from 1 April 2010 to 31 March 2012. IDA was defined as a hemoglobin level of <135 g/l for males and <120 g/l for females, combined with a serum ferritin level of <33.71 pmol/l. Of the 472 patients who had been diagnosed with IDA, 347 patients underwent either a gastroscopy and/or colonoscopy, including 120 patients who had undergone both gastroscopy and colonoscopy, 197 patients who only underwent gastroscopy, and 30 patients who only underwent colonoscopy. In total, 125/472 patients diagnosed with IDA did not undergo a gastroscopy or a colonoscopy. From the 50 patients who were diagnosed with cancer as a result of the investigation, 24 patients had gastric cancer and 23 patients had colorectal cancer. Of the gastric cancer patients, 6 patients were stage I, 3 patients stage II, 5 patients were stage III and 9 patients were stage IV. In colorectal cancer, 9 patients were stage II, 8 patients were stage III and 4 patients were stage IV. Curative surgery including endoscopic treatment was performed on 14 gastric cancer patients and 17 colorectal cancer patients of stage III or lower. Malignancies were found in 50 patients with IDA, and curative surgery was performed on >50% of the patients.
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Affiliation(s)
- Kenta Kawasaki
- Department of Gastroenterology, Asahi General Hospital, Asahi, Chiba 289-2511, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Kenji Shimura
- Department of Gastroenterology, Asahi General Hospital, Asahi, Chiba 289-2511, Japan
| | - Akira Nakamura
- Department of Gastroenterology, Asahi General Hospital, Asahi, Chiba 289-2511, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Hiromasa Takaishi
- Keio Cancer Center, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
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20
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Townsend SA, Cheung D, Horne E, Ransford R. A 5-Year Follow-Up of Study Patients With Asymptomatic Iron-Deficiency Anemia Using a Nurse-Led Pathway. Gastroenterol Nurs 2017; 39:466-471. [PMID: 27922517 DOI: 10.1097/sga.0000000000000200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A protocol-driven, systematic pathway was developed to allow rapid and coordinated investigation of patients with iron-deficiency anemia (IDA) in a nurse-delivered outpatient setting. The study objective was to assess the safety and efficacy of the pathway by 5-year outcome data for the exclusion of gastrointestinal (GI) malignancy. This is a 5-year follow-up study of 122 patients entered onto the pathway with negative initial upper and lower GI investigations. The study was conducted at Hereford County Hospital NHS Trust (a district general hospital serving 220,00 people). Clinical outcomes of patients at 5 years and service efficiency at detecting relevant pathology were observed. A total of 272 patients were investigated through the pathway, and in 150 patients a GI cause for IDA was found. We established the outcome in 97% of the 122 patients with normal GI investigation at 5 years after their initial investigation. Of the 118 patients followed up, 92 patients were alive and well and 26 had died or developed malignancy. With the exception of diabetes (odds ratio 0.24; 95% confidence interval [0.1, 0.8]; p = .02), no features were found to be a significant risk factor for poor prognosis, including age, gender, hemoglobin level, anemia at 3 months, or other comorbidities. Three patients developed colonic malignancy; two patients had diverticular disease at barium enema and presented 4 years later with colorectal cancer. One patient declined lower GI investigation and presented with metastatic colon cancer on computed tomography scan at 1 year. No other GI cancers were diagnosed. Our nurse-delivered, protocol-driven pathway is a highly effective and safe system for the exclusion of GI cancer within 5 years of follow-up.
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Affiliation(s)
- Sarah Ann Townsend
- Sarah Ann Townsend, MBChB, MRCP, is Gastroenterology Registrar, Queen Elizabeth Hospital, Birmingham, United Kingdom. Danny Cheung, MBChB, MRCP, is Gastroenterology Registrar, Sandwell General Hospital, Gastroenterology, Birmingham, United Kingdom. Elaine Horne, BSC (Hons), RN, is Specialist Nurse, Hereford County Hospital, Gastroenterology, Hereford, United Kingdom. Rupert Ransford, MBChB, MRCP, MD, is Consultant Gastroenterologist, Hereford County Hospital, Gastroenterology, Hereford, United Kingdom
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21
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Yung DE, Rondonotti E, Giannakou A, Avni T, Rosa B, Toth E, Lucendo AJ, Sidhu R, Beaumont H, Ellul P, Negreanu L, Jiménez-Garcia VA, McNamara D, Kopylov U, Elli L, Triantafyllou K, Shibli F, Riccioni ME, Bruno M, Dray X, Plevris JN, Koulaouzidis A, Argüelles-Arias F, Becq A, Branchi F, Tejero-Bustos MÁ, Cotter J, Eliakim R, Ferretti F, Gralnek IM, Herrerias-Gutierrez JM, Hussey M, Jacobs M, Johansson GW, McAlindon M, Montiero S, Nemeth A, Pennazio M, Rattehalli D, Stemate A, Tortora A, Tziatzios G. Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy. United European Gastroenterol J 2017; 5:974-981. [PMID: 29163963 DOI: 10.1177/2050640617692501] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/11/2017] [Indexed: 12/18/2022] Open
Abstract
Background Recent data imply young patients (age ≤50 years) undergoing small-bowel (SB) capsule endoscopy (CE) for iron deficiency anaemia (IDA) show higher diagnostic yield (DY) for sinister pathology. We aimed to investigate DY of CE in a large cohort of young IDA patients, and evaluate factors predicting significant SB pathology. Materials and methods This was a retrospective, multicentre study (2010-2015) in consecutive, young patients (≤50 years) from 18 centres/12 countries, with negative bidirectional gastrointestinal (GI) endoscopy undergoing SBCE for IDA. Exclusion criteria: previous/ongoing obscure-overt GI bleeding; age <19 or >50 years; comorbidities associated with IDA. Data retrieved: SBCE indications; prior investigations; medications; SBCE findings; final diagnosis. Clinical and laboratory data were analysed by multivariate logistic regression. Results Data on 389 young IDA patients were retrieved. In total, 169 (43.4%) were excluded due to incomplete clinical data; data from 220 (122F/98M; mean age 40.5 ± 8.6 years) patients were analysed. Some 71 patients had at least one clinically significant SBCE finding (DY: 32.3%). They were divided into two groups: neoplastic pathology (10/220; 4.5%), and non-neoplastic but clinically significant pathology (61/220; 27.7%). The most common significant but non-neoplastic pathologies were angioectasias (22/61) and Crohn's disease (15/61). On multivariate analysis, weight loss and lower mean corpuscular volume(MCV) were associated with significant SB pathology (OR: 3.87; 95%CI: 1.3-11.3; p = 0.01; and OR: 0.96; 95%CI: 0.92-0.99; p = 0.03; respectively). Our model also demonstrates association between use of antiplatelets and significant SB pathology, although due to the small number of patients, definitive conclusions cannot be drawn. Conclusion In IDA patients ≤50 years with negative bidirectional GI endoscopy, overall DY of SBCE for clinically significant findings was 32.3%. Some 5% of our cohort was diagnosed with SB neoplasia; lower MCV or weight loss were associated with higher DY for SB pathology.
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Affiliation(s)
- Diana E Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andry Giannakou
- Faculty of Economics and Management, The Open University of Cyprus, Nicosia, Cyprus
| | - Tomer Avni
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
| | - Hanneke Beaumont
- Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Malta
| | - Lucian Negreanu
- Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest
| | | | - Deidre McNamara
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Dept of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Fahmi Shibli
- Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel
| | | | - Mauro Bruno
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Xavier Dray
- Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France
| | - John N Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Koulaouzidis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Aymeric Becq
- Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France
| | - Federica Branchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Jose Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Francesca Ferretti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Mary Hussey
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Maarten Jacobs
- Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Mark McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
| | - Sara Montiero
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Artur Nemeth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Marco Pennazio
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Deepa Rattehalli
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
| | - Ana Stemate
- Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest
| | | | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Dept of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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22
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Affiliation(s)
| | - Jonathan Bromley
- Consultant physician, Gastroenterologist and General Medicine, Canberra Hospital
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Clere-Jehl R, Sauleau E, Ciuca S, Schaeffer M, Lopes A, Goichot B, Vogel T, Kaltenbach G, Bouvard E, Pasquali JL, Sereni D, Andres E, Bourgarit A. Outcome of endoscopy-negative iron deficiency anemia in patients above 65: A longitudinal multicenter cohort. Medicine (Baltimore) 2016; 95:e5339. [PMID: 27893668 PMCID: PMC5134861 DOI: 10.1097/md.0000000000005339] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
After the age of 65 years, iron deficiency anemia (IDA) requires the elimination of digestive neoplasia and is explored with upper and lower gastrointestinal (GI) endoscopy. However, such explorations are negative in 14% to 37% of patients. To further evaluate this issue, we evaluated the outcomes of patients aged over 65 years with endoscopy-negative IDA.We retrospectively analyzed the outcomes of in-patients over the age of 65 years with IDA (hemoglobin <12 g/dL and ferritin <70 μg/L) who had negative complete upper and lower GI endoscopies in 7 tertiary medical hospitals. Death, the persistence of anemia, further investigations, and the final diagnosis for IDA were analyzed after at least 12 months by calling the patients' general practitioners and using hospital records.Between 2004 and 2011, 69 patients (74% women) with a median age of 78 (interquartile range (IQR) 75-82) years and hemoglobin and ferritin levels of 8.4 (IQR 6.8-9.9) g/dL and 14 (IQR 8-27) μg/L, respectively, had endoscopy-negative IDA, and 73% of these patients received daily antithrombotics. After a follow-up of 41 ± 22 months, 23 (33%) of the patients were dead; 5 deaths were linked with the IDA, and 45 (65%) patients had persistent anemia, which was significantly associated with death (P = 0.007). Further investigations were performed in 45 patients; 64% of the second-look GI endoscopies led to significant changes in treatment compared with 25% for the capsule endoscopies. Conventional diagnoses of IDA were ultimately established for 19 (27%) patients and included 3 cancer patients. Among the 50 other patients, 40 (58%) had antithrombotics.In endoscopy-negative IDA over the age of 65 years, further investigations should be reserved for patients with persistent anemia, and second-look GI endoscopy should be favored. If the results of these investigations are negative, the role of antithrombotics should be considered.
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Affiliation(s)
- Raphaël Clere-Jehl
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
| | - Erik Sauleau
- Medical Information and Statistics Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg
| | - Stefan Ciuca
- Internal Medicine Department, Saint-Louis Hospital
| | - Mickael Schaeffer
- Medical Information and Statistics Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg
| | - Amanda Lopes
- Internal Medicine Department, Lariboisière Hospital, APHP, University Hospital of Paris, Paris
| | - Bernard Goichot
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
| | - Thomas Vogel
- Geriatric Department, Robertsau Hospital, University Hospital of Strasbourg, Strasbourg
| | - Georges Kaltenbach
- Geriatric Department, Robertsau Hospital, University Hospital of Strasbourg, Strasbourg
| | - Eric Bouvard
- Acute Gerontology Department, Tenon Hospital, APHP, University Hospital of Paris, Paris
| | | | | | - Emmanuel Andres
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Bourgarit
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
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Abstract
Autoimmune gastritis is a chronic inflammatory disease with destruction of parietal cells of the corpus and fundus of the stomach. The known consequence is vitamin B12 deficiency and, consequently, pernicious anemia. However, loss of parietal cells reduces secretion of gastric acid which is also required for absorption of inorganic iron; thus, iron deficiency is commonly found in patients with autoimmune gastritis. This usually precedes vitamin B12 deficiency and is found mainly in young women. Patients with chronic iron deficiency, especially those refractory to oral iron therapy, should therefore be evaluated for the presence of autoimmune gastritis.
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Affiliation(s)
- Stefanie Kulnigg-Dabsch
- Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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GIST 2.0: A scalable multi-trait metric for quantifying population representativeness of individual clinical studies. J Biomed Inform 2016; 63:325-336. [PMID: 27600407 DOI: 10.1016/j.jbi.2016.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/02/2016] [Accepted: 09/02/2016] [Indexed: 12/20/2022]
Abstract
The design of randomized controlled clinical studies can greatly benefit from iterative assessments of population representativeness of eligibility criteria. We propose a multi-trait metric - GIST 2.0 that can compute the a priori generalizability based on the population representativeness of a clinical study by explicitly modeling the dependencies among all eligibility criteria. We evaluate this metric on twenty clinical studies of two diseases and analyze how a study's eligibility criteria affect its generalizability (collectively and individually). We statistically analyze the effects of trial setting, trait selection and trait summarizing technique on GIST 2.0. Finally we provide theoretical as well as empirical validations for the expected properties of GIST 2.0.
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Reinisch W, Altorjay I, Zsigmond F, Primas C, Vogelsang H, Novacek G, Reinisch S, Thomsen LL. A 1-year trial of repeated high-dose intravenous iron isomaltoside 1000 to maintain stable hemoglobin levels in inflammatory bowel disease. Scand J Gastroenterol 2016; 50:1226-33. [PMID: 25900645 PMCID: PMC4673551 DOI: 10.3109/00365521.2015.1031168] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Iron isomaltoside 1000 (Monofer®) is a high-dose intravenous (IV) iron, which in a recent 8 weeks trial in inflammatory bowel disease (IBD) subjects with iron deficiency anemia (IDA) demonstrated good tolerability and efficacy. The present trial is an extension to this trial, which evaluates the need for additional high IV iron doses to maintain a stable hemoglobin (Hb) ≥12.0 g/dl. MATERIAL AND METHODS This was a prospective, open-label, 12 months trial of European IBD subjects willing to participate after completing the lead-in trial. Subjects were allowed re-dosing with 500-2000 mg single doses of iron isomaltoside 1000 infused over ∼15 min at 3 months intervals depending on a predefined algorithm. Outcome measures included Hb, safety parameters and need for additional iron dosing. RESULTS A total of 39 subjects were enrolled of which 34 subjects required re-dosing with a median cumulative 1-year dose of 1.8 g (mean cumulative dose 2.2 g). The mean (SD) Hb was 12.3 (1.5) g/dl at baseline, 12.8 (1.6) g/dl at 3 months, 12.8 (1.6) g/dl at 6 months, 12.9 (1.4) g/dl at 9 months and 12.9 (1.6) g/dl at 12 months. Seventy-four percent of subjects who had an Hb ≥12.0 g/dl at baseline were able to maintain Hb ≥12.0 g/dl till the end of the trial at 12 months. Nonserious probably related hypersensitivity reactions without significant hypotension were reported at the beginning of the infusion in two subjects, who recovered without sequelae. CONCLUSION Repeated treatment of iron deficiency with iron isomaltoside 1000 could avoid episodes of IDA without major safety issues.
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Affiliation(s)
- Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, AKH, Vienna, Austria,Divison of Gastroenterology, McMaster University, Ontario, Canada,Correspondence: Walter Reinisch, Divison of Gastroenterology, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. +1 905 525 9140. +1 905 521 4958.
| | - Istvan Altorjay
- University of Debrecen Medical and Health Science Centre, Debrecen, Hungary
| | - Ferenc Zsigmond
- Gastroenterology Department, Military Hospital, Budapest, Hungary
| | - Christian Primas
- Department of Internal Medicine III, Medical University of Vienna, AKH, Vienna, Austria
| | - Harald Vogelsang
- Department of Internal Medicine III, Medical University of Vienna, AKH, Vienna, Austria
| | - Gottfried Novacek
- Department of Internal Medicine III, Medical University of Vienna, AKH, Vienna, Austria
| | - Sieglinde Reinisch
- Department of Internal Medicine III, Medical University of Vienna, AKH, Vienna, Austria,Divison of Gastroenterology, McMaster University, Ontario, Canada
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Mogilevski T, Smith R, Johnson D, Charles PGP, Churilov L, Vaughan R, Ma R, Testro A. Endoscopic investigation in non-iron deficiency anemia: a cost to the health system without patient benefit. Endosc Int Open 2016; 4:E198-201. [PMID: 26878049 PMCID: PMC4751016 DOI: 10.1055/s-0041-109768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/04/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS The indication for endoscopy to investigate anemia of causes other than iron deficiency is not clear. Increasing numbers of endoscopic procedures for anemia raises concerns about costs to the health system, waiting times, and patient safety. The primary aim of this study was to determine the diagnostic yield of endoscopy in patients referred to undergo investigation for anemia. Secondary aims were to identify additional factors enabling the risk stratification of those likely to benefit from endoscopic investigation, and to undertake a cost analysis of performing endoscopy in this group of patients. METHODS We performed a retrospective review of endoscopy referrals for the investigation of anemia over a 12-month period at a single center. The patients were divided into three groups: those who had true iron deficiency anemia (IDA), tissue iron deficiency without anemia (TIDWA), or anemia of other cause (AOC). Outcome measures included finding a lesion responsible for the anemia and a significant change of management as a result of endoscopy. A costing analysis was performed with an activity-based costing method. RESULTS We identified 283 patients who underwent endoscopy to investigate anemia. A likely cause of anemia was found in 31 of 150 patients with IDA (21 %) and 0 patients in the other categories (P < 0.001). A change of management was observed in 35 patients with IDA (23 %), 1 of 14 patients with TIDWA (7.14 %), and 8 of 119 patients with AOC (6.7 %) (P < 0.001). The cost of a single colonoscopy or gastroscopy was approximated to be $ 2209. CONCLUSIONS Endoscopic investigation for non-IDA comes at a significant cost to our institution, equating to a minimum of $ 293 797 per annum in extra costs, and does not result in a change of management in the majority of patients. No additional factors could be established to identify patients who might be more likely to benefit from endoscopic investigation. The endoscopic investigation of non-IDA should be minimized.
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Affiliation(s)
- Tamara Mogilevski
- Department of Gastroenterology, Austin Health, Heidelberg, Melbourne, Australia,Corresponding author Tamara Mogilevski, MD Department of GastroenterologyAustin Health, HeidelbergMelbourneAustralia 3084
| | - Rebecca Smith
- Department of Gastroenterology, Austin Health, Heidelberg, Melbourne, Australia
| | - Douglas Johnson
- Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Australia,Department of General Medicine, Austin Health, Heidelberg, Melbourne, Australia
| | - Patrick G. P. Charles
- Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Australia,The University of Melbourne (Austin Health), Melbourne, Victoria, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology, Austin Health, Heidelberg, Melbourne, Australia,The University of Melbourne (Austin Health), Melbourne, Victoria, Australia
| | - Ronald Ma
- Department of Clinical Costing, Austin Health, Heidelberg, Melbourne, Australia
| | - Adam Testro
- Department of Gastroenterology, Austin Health, Heidelberg, Melbourne, Australia
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Abstract
OPINION STATEMENT Anaemia is a common multifactorial extraintestinal manifestation in IBD patients. Moreover, anaemia represents an important health problem among the elderly population and has a significant impact on healthcare utilisation and costs. Data on the prevalence, diagnosis and management of anaemia in elderly IBD patients are scarce, since clinical trials have largely excluded this population. In this review, we reconsider anaemia in older IBD patients in the light of new diagnostic and therapeutic tools.
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Affiliation(s)
- Jürgen Stein
- Gastroenterology and Clinical Nutrition, DGD Clinics Frankfurt-Sachsenhausen, Teaching Hospital of the Goethe University Frankfurt, Schulstrasse 31, 60594, Frankfurt/Main, Germany,
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Nielsen OH, Ainsworth M, Coskun M, Weiss G. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review. Medicine (Baltimore) 2015; 94:e963. [PMID: 26061331 PMCID: PMC4616486 DOI: 10.1097/md.0000000000000963] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics. In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron.
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Affiliation(s)
- Ole Haagen Nielsen
- From the Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark (OHN, MA, MC); and Department of Internal Medicine VI, Medical University of Innsbruck, Innsbruck, Austria (GW)
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30
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Chronic iron deficiency as an emerging risk factor for osteoporosis: a hypothesis. Nutrients 2015; 7:2324-44. [PMID: 25849944 PMCID: PMC4425147 DOI: 10.3390/nu7042324] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 01/25/2023] Open
Abstract
Iron is essential in oxygen transport and participates in many enzymatic systems in the body, with important roles in collagen synthesis and vitamin D metabolism. The relationship between iron and bone health comes from clinical observations in iron overload patients who suffered bone loss. The opposite scenario—whether iron deficiency, with or without anemia, affects bone metabolism—has not been fully addressed. This is of great interest, as this nutrient deficiency is a worldwide public health problem and at the same time osteoporosis and bone alterations are highly prevalent. This review presents current knowledge on nutritional iron deficiency and bone remodeling, the biomarkers to evaluate iron status and bone formation and resorption, and the link between iron and bone metabolism. Finally, it is hypothesized that chronic iron deficiency induces bone resorption and risk of osteoporosis, thus complete recovery from anemia and its prevention should be promoted in order to improve quality of life including bone health. Several mechanisms are suggested; hence, further investigation on the possible impact of chronic iron deficiency on the development of osteoporosis is needed.
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Gawde SR, Patel TC, Rege NN, Gajbhiye S, Uchil D. Evaluation of effects of Maṇḍurabhasma on structural and functional integrity of small intestine in comparison with ferrous sulfate using an experimental model of iron deficiency anemia. Anc Sci Life 2015; 34:134-41. [PMID: 26120227 PMCID: PMC4458903 DOI: 10.4103/0257-7941.157157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The present study was planned to assess effects of Maṇḍurabhasma (MB) on structural and functional integrity of small intestine using an animal model of iron deficiency anemia (IDA) in rat. Methods: IDA was induced by giving iron deficient diet and retro-orbital bloodletting for 21 days in Wistar female rats. Rats (n = 72) were divided into six groups: (i) Control group, (ii) IDA rats, (iii) IDA rats receiving vehicle, (iv) rats receiving ferrous sulfate (40 mg/kg), (vi) rats receiving a low dose (22.5 mg/kg) of MB, (vi) rats receiving a high dose (45 mg/kg) of MB. Treatment was conducted for a period of 21 days followed by an assessment of change in hemoglobin (Hb) levels, lactase levels, lipid peroxidation activity by measuring malondialdehyde (MDA) levels and jejunal morphometry. Results: In the present study, the lactase activity was markedly reduced in iron-deficient rats. Our study has demonstrated that intestinal morphology and MDA levels were not altered in the animals with IDA as compared to normal animals. In phase II, improvement in Hb response to ferrous sulfate was accompanied by an improvement in lactase activity. However, it significantly increased MDA levels with derangement of the normal villous structure. Rats receiving a low dose of MB did not have increased MDA levels. It did not alter the jejunal villous structure and improved lactase activity, but hematinic activity was found to be less than that of ferrous sulfate. Rats receiving a high dose of MB showed significantly improved Hb as well as lactase levels. They exhibited damage to the villous structure and increased MDA levels, but the effects were significantly less as compared to ferrous sulfate group. Conclusion: Rats receiving a high dose of MB have shown improvement in hematinic and lactase levels comparable to those receiving ferrous sulfate. However, it causes lesser oxidative damage as compared to ferrous sulfate. This is an encouraging finding because it indicates the potential of MB to cause lesser gastrointestinal side effects compared to ferrous sulfate.
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Affiliation(s)
- Suchita Rajanikant Gawde
- Department of Pharmacology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Tejal C Patel
- Department of Pharmacology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Nirmala N Rege
- Department of Pharmacology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Snehalata Gajbhiye
- Department of Pharmacology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Dinesh Uchil
- Department of Pharmacology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
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Affiliation(s)
- Charles R Boardman
- Portland VA Medical Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Amnon Sonnenberg
- Portland VA Medical Center, Oregon Health & Science University, Portland, Oregon, USA
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Song P, Li L, Man Q, Wang C, Meng L, Zhang J. Case-control study of anaemia among middle-aged and elderly women in three rural areas of China. BMJ Open 2014; 4:e004751. [PMID: 25138800 PMCID: PMC4139636 DOI: 10.1136/bmjopen-2013-004751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 07/07/2014] [Accepted: 07/21/2014] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To propose a feasible suggestion to reduce the high prevalence of anaemia in middle-aged and elderly women by investigating risk factors, particularly nutritional factors, and analysing the effect on anaemia in three different rural areas of China. DESIGN A case-control study. SETTING Three counties of China. PARTICIPANTS Women aged 50-75 years in the three counties. MAIN OUTCOME MEASURES Adjusted OR (95% CI) of anaemia associated with diet, lifestyle and blood biochemical indices. RESULTS Compared with controls, women with anaemia had lower body mass index (22.1 (3.2) kg/m(2) vs 23.2 (3.5) kg/m(2); p<0.001), a higher experience of shortage of food (45.0% vs 36.5%; p<0.001), less soy food intake (0.5 (0.3, 26.7) g/day vs 5.6 (0.4, 27.8) g/day; p<0.048), lower serum iron (13.4 (5.4) μmol/L vs 16.4 (5.7) μmol/L; p<0.001), lower ferritin (109.6 (85.6) ng/mL vs 131.0 (92.0) ng/mL; p<0.001), lower transferrin saturation levels (22.5 (9.5)% vs 26.8 (9.6)%; p<0.001) and higher levels of free erythrocyte protoporphyrin (42.4 (21.2) μg/dL vs 39.6 (17.8) μg/dL; p<0.001). Anaemia was significantly associated with BMI(OR=0.90, 95% CI (0.87 to 0.92)), food shortage experience (OR=1.39, 95% CI (1.15 to 1.69)), total protein (OR=0.66, 95%CI (0.54 to 0.80)), Albumin (OR=0.72, 95%CI (0.59 to 0.87)) in univariate analysis. Multivariate analysis showed that body mass index, experience of food shortage, total protein and albumin were independently related to anaemia. CONCLUSIONS Among middle-aged and elderly women in rural China, the nutrition status of anaemic cases is far below that of controls. Lower body mass index and a greater experience of food shortage are closely related to anaemia. Improving the blood protein status by consuming protein-sufficient foods such as soy food is a feasible approach for elderly anaemic women. Further research is needed on the effect of chronic inflammation and infectious disease on anaemia in elderly women in rural China.
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Affiliation(s)
- Pengkun Song
- Elderly and Clinical Nutrition Laboratory, Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lixiang Li
- Elderly and Clinical Nutrition Laboratory, Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingqing Man
- Elderly and Clinical Nutrition Laboratory, Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunrong Wang
- Elderly and Clinical Nutrition Laboratory, Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liping Meng
- Elderly and Clinical Nutrition Laboratory, Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Zhang
- Elderly and Clinical Nutrition Laboratory, Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
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Transfusion-Dependent Anaemia: An Overlooked Complication of Paraoesophageal Hernias. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:479240. [PMID: 27379280 PMCID: PMC4897576 DOI: 10.1155/2014/479240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/25/2014] [Accepted: 06/02/2014] [Indexed: 02/06/2023]
Abstract
Introduction. A paraoesophageal hernia (PH) may be one reason for iron-deficiency anaemia (IDA) but is often overlooked as a cause. We aimed to assess the incidence and resolution of transfusion-dependent IDA in patients presenting for hiatal hernia surgery. Methods. We analysed a prospective database of patients undergoing laparoscopic hiatal repair in order to identify patients with severe IDA requiring red cell/iron transfusion. Results. Of 138 patients with PH managed over a 4-year period, 7 patients (5.1%; M : F 2 : 5; median age 62 yrs (range 57-82)) with IDA requiring red cell/iron transfusion were identified. Preoperatively, 3/7 patients underwent repetitive and unnecessary diagnostic endoscopic investigations prior to surgery. Only 2/7 ever demonstrated gastric mucosal erosions (Cameron ulcers). All patients were cured from anaemia postoperatively. Discussion. PH is an important differential diagnosis in patients with IDA, even those with marked anaemia and no endoscopically identifiable mucosal lesions. Early recognition can avoid unnecessary additional diagnostic endoscopies. Laparoscopic repair is associated with low morbidity and results in resolution of anaemia.
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Martinsson A, Andersson C, Andell P, Koul S, Engström G, Smith JG. Anemia in the general population: prevalence, clinical correlates and prognostic impact. Eur J Epidemiol 2014; 29:489-98. [DOI: 10.1007/s10654-014-9929-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
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Hettiarachchi M, Fonseka CL, Gunasekara P, Jayasinghe P, Maduranga D. How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka? MEDICAL EDUCATION ONLINE 2014; 19:22772. [PMID: 24559505 PMCID: PMC3933711 DOI: 10.3402/meo.v19.22772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/04/2013] [Accepted: 01/22/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Individual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students' quality of life (QoL) and certain biochemical changes occurring while they are preparing for examinations has not been explored. PURPOSE We hypothesize that these parameters would determine the examination performance among medical students. METHODS Fourth-year medical students (n=78) from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin) were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination. RESULTS The mean QoL score was significantly lower at pre-exam (56.19±8.1) when compared with post-exam (61.7±7.1) levels (p<0.001). The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74-1.4 mIU/L) was significantly lower (p=0.001) when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90-3.60). The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001). Median serum ferritin (SF) level prior to the exam (43.15 (23.5-63.3) µg/L) was significantly lower (p≤0.001) when compared with after-exam status (72.36 (49.9-94.9) µg/L). However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41). CONCLUSIONS Students had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological, Social interaction and Environment). The higher the QoL scores, the better the grades were. It was also found that students who failed exhibited profound differences in the QoL score.
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Wiland HO, Henricks WH, Daly TM. Limited utilization of serologic testing in patients undergoing duodenal biopsy for celiac disease. BMC Gastroenterol 2013; 13:156. [PMID: 24209459 PMCID: PMC4225746 DOI: 10.1186/1471-230x-13-156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 11/04/2013] [Indexed: 01/31/2023] Open
Abstract
Background Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. However, the majority of duodenal biopsies submitted to pathology for “rule out celiac” are negative. The objective of this study was to determine the underlying causes for this low diagnostic yield. Methods We performed a retrospective review of pathology reports from 1432 consecutive duodenal biopsies submitted for pathologic assessment to “rule out celiac” and correlated biopsy results with results for concurrent serologic testing for celiac autoantibodies. Results The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients. Most duodenal biopsies were submitted as part of a multi-site GI sampling strategy that included biopsies from other locations. In this context, serologic results correlated with the likelihood of significant duodenal and non-duodenal findings, and were also helpful in evaluating patients with indeterminate duodenal histology. Conclusions The presence of a positive screening test for celiac autoantibodies does not appear to be a major driver in the decision to submit duodenal biopsies for evaluation of celiac disease, which accounts for the low incidence of findings in these samples. In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.
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Affiliation(s)
| | | | - Thomas M Daly
- Robert J, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Clinical Pathology, LL3-3, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.
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Karagülle M, Gündüz E, Sahin Mutlu F, Olga Akay M. Clinical significance of reticulocyte hemoglobin content in the diagnosis of iron deficiency anemia. Turk J Haematol 2013; 30:153-6. [PMID: 24385778 PMCID: PMC3878462 DOI: 10.4274/tjh.2012.0107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/12/2013] [Indexed: 12/01/2022] Open
Abstract
Objective: The aim of this study was to evaluate the clinical significance of reticulocyte hemoglobin content (CHr) in the diagnosis of iron deficiency anemia (IDA) and to compare it with other conventional iron parameters. Materials and Methods: A total of 32 female patients with IDA (serum hemoglobin <120 g/L and serum ferritin <20 ng/ mL) and 18 female patients with iron deficiency (serum hemoglobin > 120 g/L and serum ferritin <20 ng/mL) were enrolled. Results: CHr was 24.95±3.92 pg in female patients with IDA and 29.93±2.96 pg in female patients with iron deficiency. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, and transferrin saturation and a significant negative correlation with transferrin and total iron-binding capacity. The cut-off value of CHr for detecting IDA was 29 pg. Conclusion: Our data demonstrate that CHr is a useful parameter that can be confidently used in the diagnosis of IDA, and a CHr cut-off value of 29 pg predicts IDA. Conflict of interest:None declared.
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Affiliation(s)
- Mustafa Karagülle
- Eskişehir Osmangazi University Medical School, Department of Hematology, Eskişehir, Turkey
| | - Eren Gündüz
- Eskişehir Osmangazi University Medical School, Department of Hematology, Eskişehir, Turkey
| | - Fezan Sahin Mutlu
- Eskişehir Osmangazi University Medical School, Department of Biostatistics, Eskişehir, Turkey
| | - Meltem Olga Akay
- Eskişehir Osmangazi University Medical School, Department of Hematology, Eskişehir, Turkey
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Yewale VN, Dewan B. Treatment of iron deficiency anemia in children: a comparative study of ferrous ascorbate and colloidal iron. Indian J Pediatr 2013. [PMID: 23180405 DOI: 10.1007/s12098-012-0906-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the efficacy of ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia in children. METHODS Eighty one children, aged 6 mo to 12 y, were screened for iron deficiency anemia (IDA) and those diagnosed with IDA were randomized to receive ferrous ascorbate or colloidal iron for a period of 12 wk, such that each child received elemental iron 3 mg/kg body weight/d. Increase in hemoglobin (Hb) level was the primary outcome measure. Assessment was performed at baseline, wk 4, wk 8 and wk 12. RESULTS Of 81 children screened, 73 were included in the study. The mean rise in Hb at the end of the 12 wk was significantly higher in ferrous ascorbate group than the colloidal iron group [3.59 ± 1.67 g/dl vs. 2.43 ± 1.73 g/dl; P < 0.01]. Significantly higher proportion of children receiving ferrous ascorbate (64.86 % vs. 31.03 %; P < 0.01) became non-anemic in comparison to colloidal iron. CONCLUSIONS Ferrous ascorbate provides a significantly higher rise in hemoglobin levels in comparison to colloidal iron. The study supports the use of ferrous ascorbate in the pediatric age group, providing evidence for its role as an efficient oral iron supplement in the treatment of iron deficiency anemia.
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Affiliation(s)
- Vijay N Yewale
- Department of Pediatrics, Dr. Yewale's Hospital & Vashi Criticare Tertiary Care Hospital, Navi Mumbai, India
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Long-term outcomes and prognostic factors for patients with endoscopy-negative iron deficiency. Dig Dis Sci 2013; 58:488-95. [PMID: 22945477 PMCID: PMC4783144 DOI: 10.1007/s10620-012-2368-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 08/08/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM 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.
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Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy 2012; 2012:630519. [PMID: 22792466 PMCID: PMC3389687 DOI: 10.1155/2012/630519] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/04/2012] [Accepted: 04/18/2012] [Indexed: 12/15/2022] Open
Abstract
Nutritional iron-deficiency anaemia (IDA) is the most common disorder in the world, affecting more than two billion people. The World Health Organization's global database on anaemia has estimated a prevalence of 14% based on a regression-based analysis. Recent data show that the prevalence of IDA in pregnant women in industrialized countries is 17.4% while the incidence of IDA in developing countries increases significantly up to 56%. Although oral iron supplementation is widely used for the treatment of IDA, not all patients respond adequately to oral iron therapy. This is due to several factors including the side effects of oral iron which lead to poor compliance and lack of efficacy. The side effects, predominantly gastrointestinal discomfort, occur in a large cohort of patients taking oral iron preparations. Previously, the use of intravenous iron had been associated with undesirable and sometimes serious side effects and therefore was underutilised. However, in recent years, new type II and III iron complexes have been developed, which offer better compliance and toleration as well as high efficacy with a good safety profile. In summary, intravenous iron can be used safely for a rapid repletion of iron stores and correction of anaemia during and after pregnancy.
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Is routine duodenal biopsy necessary for the detection of celiac disease in patients presenting with iron deficiency anemia? Int J Prev Med 2012; 3:273-7. [PMID: 22624084 PMCID: PMC3354397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/04/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUNDS Iron deficiency anemia (IDA) is one of the well recognized presentations of celiac disease (CD). According to the lack of data from our population in this regard, we determined the prevalence of CD in patients presenting with IDA to see if it is worthwhile to do a precise screening for CD in such patients. METHODS This cross-sectional study was conducted on patients referred with IDA to Poursina Hakim Gastroenterology Clinic, Isfahan (IRAN). All included patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Also, patients were evaluated for IgA anti-tissue transglutaminase (t-TG) antibody with enzyme-linked immunosorbent assay (ELISA) technique. CD was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten free diet (GFD). RESULTS During the study, 130 patients with the mean age of 35.5±13.7 (67.7% female [20.4% post-menopausal]) were undergone seropathological studies. According to histopathological study and a clinical response to GFD, 13 patients (10%) were ultimately diagnosed with CD. Nine patients (6.9%) were seropositive, from which, five patients (3.8%) were ultimately diagnosed as CD cases. IgA anti-tTG became negative in all of these patients after six months of GFD. CONCLUSION CD should be considered in any adult patient presenting with unexplained IDA, even if not accompanied with gastrointestinal symptoms. Routine duodenal biopsy performed during diagnostic upper gastrointestinal endoscopy is worthwhile in order to investigate for CD as an underlying cause of IDA in adult patients.
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Monzón H, Forné M, González C, Esteve M, Martí JM, Rosinach M, Mariné M, Loras C, Espinós JC, Salas A, Viver JM, Fernández-Bañares F. Mild enteropathy as a cause of iron-deficiency anaemia of previously unknown origin. Dig Liver Dis 2011; 43:448-53. [PMID: 21233030 DOI: 10.1016/j.dld.2010.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/04/2010] [Accepted: 12/02/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We assessed whether mild enteropathy with negative coeliac serology may be gluten-dependent, and a cause of iron-deficiency anaemia. In cases not responding to gluten-free diet, the role of Helicobacter pylori infection was evaluated. METHODS 55 consecutive unexplained iron-deficiency anaemia patients were included. In all of them we performed: HLA-DQ2/DQ8 coeliac genetic study, distal duodenum biopsies, and tests to assess H. pylori infection. A gluten-free diet or H. pylori eradication was used as indicated. Final diagnosis was established based on response to specific therapy after a 12-month follow-up period. RESULTS Histological findings were: (1) group A (positive genetics): 21 Marsh I, 2 Marsh IIIA, 12 normal; (2) group B (negative genetics): 16 Marsh I, 4 normal. Final diagnosis of anaemia in patients with enteropathy were: group A, gluten-sensitive enteropathy, 45%; H. pylori infection, 20%; gluten-sensitive enteropathy plus H. pylori, 10%; other, 10%; unknown, 15%; group B, gluten-sensitive enteropathy, 10%; H. pylori infection, 0% (1 non-eradicated case, 10%); non-steroidal anti-inflammatory drug intake, 20%; other, 20%; unknown, 40% (p=0.033). CONCLUSIONS Mild enteropathy is frequent in patients with unexplained iron-deficiency anaemia and negative coeliac serology. Most cases are secondary to either gluten-sensitive enteropathy or H. pylori infection, or both; however, there is also a substantial number of patients without a definitive diagnosis.
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Affiliation(s)
- Helena Monzón
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa and Research Foundation Mútua Terrassa, Barcelona, Spain
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Milano A, Balatsinou C, Filippone A, Caldarella MP, Laterza F, Lapenna D, Pierdomenico SD, Pace F, Cuccurullo F, Neri M. A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis. Gastrointest Endosc 2011; 73:1002-8. [PMID: 21396638 DOI: 10.1016/j.gie.2011.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 01/03/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a frequently encountered condition in clinical practice. After conventional endoscopy, the cause of anemia remains unknown in up to 40% of patients. OBJECTIVE To evaluate prospectively the diagnostic efficacy of a systematic endoscopic approach to IDA and to compare the diagnostic yield of videocapsule endoscopy (VCE) and CT-enteroclysis in endoscopy-negative patients. DESIGN Consecutive patients with IDA were enrolled prospectively. SETTING Open-access endoscopy within an academic hospital. PATIENTS This study involved 189 patients with IDA, including 98 women and 91 men; mean (±standard deviation) age 68 years±16.6 years. INTERVENTION Patients with IDA underwent gastroscopy and colonoscopy plus ileoscopy. Endoscopy-negative patients were further blindly evaluated by both CT-enteroclysis and VCE. MAIN OUTCOME MEASUREMENTS Diagnostic yield of conventional endoscopy; diagnostic yield of VCE versus CT-enteroclysis. RESULTS Endoscopy results were positive in 144 of 189 patients (76.2%). CT-enteroclysis and VCE allowed a diagnosis in 37 of 45 endoscopy-negative patients (82.2%). Overall, VCE was superior to CT-enteroclysis (77.8% vs 22.2%; P<.001), in particular when flat lesions were found. LIMITATIONS Single-center study. CONCLUSION A systematic approach to IDA, which includes standard endoscopy, VCE, and CT-enteroclysis allows an overall diagnostic rate of 95.7%; however, CT-enteroclysis should be limited to cases of nondiagnostic VCE.
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Affiliation(s)
- Angelo Milano
- Department of Medicine and Aging Sciences, Section of Internal Medicine and Gastroenterology and Center for Excellence on Ageing (Ce.S.I.), G.D'Annunzio University and Foundation, Chieti, Italy
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Serefhanoglu S, Buyukasik Y, Emmungil H, Sayinalp N, Haznedaroglu IC, Goker H, Aksu S, Ozcebe OI. Identification of clinical and simple laboratory variables predicting responsible gastrointestinal lesions in patients with iron deficiency anemia. Int J Med Sci 2010; 8:30-8. [PMID: 21209799 PMCID: PMC3014590 DOI: 10.7150/ijms.8.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 12/20/2010] [Indexed: 01/14/2023] Open
Abstract
Iron deficiency anemia (IDA) is a frequent disorder. Also, it may be a sign of underlying serious diseases. Iron deficiency points to an occult or frank bleeding lesion when occurred in men or postmenopausal women. In this study, we aimed to evaluate the diagnostic yield of endoscopy in patients with IDA and to define predictive factors of gastrointestinal (GI) lesions causing IDA. Ninety-one patients (77 women, 14 men; mean age: 43 years) who were decided to have esophago-duodenoscopy and/or colonoscopy for iron deficiency anemia were interviewed and responded to a questionnaire that included clinical and biochemical variables. The endoscopic findings were recorded as GI lesions causing IDA or not causing IDA. Endoscopy revealed a source of IDA in 18.6 % of cases. The risk factors for finding GI lesions causing IDA were as follows: male gender (p= 0.004), advanced age (> 50 years) (p= 0.010), weight loss (over 20% of total body weight lost in last 6 month) (p= 0.020), chronic diarrhea (p= 0.006), change of bowel habits (p= 0.043), epigastric tenderness (p= 0.037), raised carcinoembryonic antigen (CEA) level (normal range: 0-7 ng/mL) (p= 0.039), < 10 gr/dl hemoglobin (Hb) level (p=0.054). None of these risk factors had been present in 21 (23%) women younger than 51 years. In this group, no patient had any GI lesion likely to cause IDA (negative predictive value= 100%). In multivariate analysis, advanced age (p=0.017), male gender (p< 0.01) and weight lost (p=0.012) found that associated with GI lesions in all patients. It may be an appropriate clinical approach to consider these risk factors when deciding for gastrointestinal endoscopic evaluation in iron deficiency anemia.
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Affiliation(s)
- Songul Serefhanoglu
- Hacettepe University Hospital, Department of Internal Medicine, Division of Hematology, Ankara, Turkey.
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St. Pierre SA, Vercellotti GM, Donovan JC, Hordinsky MK. Iron deficiency and diffuse nonscarring scalp alopecia in women: More pieces to the puzzle. J Am Acad Dermatol 2010; 63:1070-6. [DOI: 10.1016/j.jaad.2009.05.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 05/05/2009] [Accepted: 05/17/2009] [Indexed: 10/19/2022]
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Shah M, Martin A, Myers B, MacSweeney S, Richards T. Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia. Ann R Coll Surg Engl 2010; 92:495-8. [PMID: 20513273 DOI: 10.1308/003588410x12664192075738] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI. PATIENTS AND METHODS Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system. RESULTS In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2-13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days). CONCLUSIONS Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.
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Affiliation(s)
- M Shah
- Medical School, University of Nottingham, Nottingham, UK.
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Gomollón F, Gisbert JP, García-Erce JA. Intravenous iron in digestive diseases: a clinical (re)view. Ther Adv Chronic Dis 2010; 1:67-75. [PMID: 23251730 PMCID: PMC3513858 DOI: 10.1177/2040622310373675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intravenous iron has been considered dangerous by many clinicians. In the last two decades, considerable experience has been gained with new formulations in different clinical settings. Data from clinical trials, observational studies, and postmarketing surveillance studies demonstrate that intravenous iron is safe and effective to treat iron deficiency and iron deficiency anaemia. Iron deficiency is particularly common in many digestive diseases: oral iron often fails while transfusions are not without considerable risks. In particular, in inflammatory bowel diseases, there is enough evidence to recommend intravenous iron in moderate-to-severe iron deficiency anaemia, in intolerance to oral iron, and in patients needing quick recovery (pre-operative setting). New formulations make treatment even easier and more convenient. Recent guidelines are available for inflammatory bowel diseases, and new guidelines in acute and chronic gastrointestinal bleeding are needed.
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Affiliation(s)
- Fernando Gomollón
- Correspondence to: Fernando Gomollón, MD, PhD Servicio de Aparato Digestivo, Hospital Clínico Universitario ‘Lozano Blesa', Avenida San Juan Bosco 15, 50009 Zaragoza, CIBEREHD, Spain
| | - Javier P. Gisbert
- Javier P. Gisbert, MD, PhD Digestive Diseases Service, Hospital ‘La Princesa', Madrid, CIBEREHD, Spain
| | - José Antonio García-Erce
- José Antonio García-Erce, MD, PhD Department of Haematology and Haemotherapy, Hospital Universitario ‘Miguel Servet', Zaragoza, Spain
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Edwards TJ, Noble EJ, Durran A, Mellor N, Hosie KB. Authors' reply: Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery ( Br J Surg 2009; 96: 1122–1128). Br J Surg 2010. [DOI: 10.1002/bjs.6982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T J Edwards
- Colorectal Unit, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E J Noble
- Colorectal Unit, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - A Durran
- Colorectal Unit, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - N Mellor
- Colorectal Unit, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - K B Hosie
- Colorectal Unit, Plymouth Hospitals NHS Trust, Plymouth, UK
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Prevalencia y características de la anemia en la enfermedad inflamatoria intestinal. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:591-9. [DOI: 10.1016/j.gastrohep.2009.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/04/2009] [Accepted: 05/29/2009] [Indexed: 02/08/2023]
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