Prevalence of gastrointestinal malignancy in non-anemic iron deficiency and significance for endoscopic screening: A Western Australian multicenter cohort study

BACKGROUND AND AIM

There is a paucity of evidence regarding non-anemic iron deficiency as a predictor for colorectal cancer and therefore the indication for endoscopic evaluation. This study explores the rates of malignancy in adults with iron deficiency with and without anemia.

METHODS

A retrospective multicenter diagnostic cohort study was conducted across two Australian health services. All cases that underwent both esophagogastroduodenoscopy and colonoscopy between September 1, 2018, and December 31, 2019, for the investigation of iron deficiency were included, and the cohort was divided into anemic and non-anemic arms. Multivariate binomial logistic regression was performed to establish clinical characteristics associated with neoplasia.

RESULTS

Five hundred eighty-four patients underwent endoscopic evaluation over a 16-month period. There was a significantly higher rate of malignancy in the iron deficiency anemia arm as compared with those without anemia (8.76% vs 1.20%, P < 0.01). Gastrointestinal pathology to account for iron deficiency was identified in > 60% of the total cohort. The presence of anemia (odds ratio [OR] 6.87, P < 0.01) and male gender (OR 3.01, P = 0.01) were significant predictors of malignancy.

CONCLUSION

This study demonstrates that anemic iron deficiency confers a significantly greater risk of gastrointestinal cancer compared with non-anemic iron deficiency. Additionally, over 60% of patients had gastrointestinal pathology to account for iron deficiency overall, supporting the need to perform baseline endoscopy in patients with iron deficiency.

A comparison of the sedative and amnestic effects of chlorpromazine and lorazepam

The effects of single doses of chlorpromazine (100 mg) and lorazepam (0.5, 1 and 2 mg) were compared with placebo in a battery of tests of information processing, working and semantic memory. Peak saccadic velocity was used to provide a precise and reliable measure of sedation and its results were found to be consistent with those using visual analogue rating scales. Chlorpromazine 100 mg was equally sedative to lorazepam 2 mg. Lorazepam caused dose-dependent deterioration in performance in many of the memory tests, whereas an equally sedative dose of chlorpromazine did not. These data therefore support the view that benzodiazepine-induced amnesia is not secondary to sedation. Peak saccadic velocity has considerable advantages over visual analogue scales as a measure of sedation, since it is objective and has a demonstrated low coefficient of variation. It is suggested that saccadic eye movement measurement will permit considerably more reliable and precise separation of the sedative and amnestic effects of drugs and will allow investigation of amnesia caused by clinically relevant doses of psychotropic drugs.