Endoscopic malignancy investigation in asymptomatic iron deficiency cases

Introduction: According to the World Health Organisation (WHO), anaemia is a haemoglobin level below 13 g/dL in adult men, 12 g/dL in non-pregnant women and 11 g/dL in pregnant women. According to the WHO Global Anaemia Database, 50% of anaemia cases are iron deficiency anaemia. The global prevalence of iron deficiency without anaemia is unknown, but the estimated figure is twice that of iron deficiency anaemia. Gastrointestinal tract (GI) bleeding is one of the most common causes of iron deficiency (ID) or iron deficiency anaemia (IDA). One of the causes of bleeding is GI malignancies. In this study, we aimed to investigate the frequency of malignancy in patients ID without anemia or IDA. Material-Method: Patients who were examined for ID without anemia or IDA and who underwent upper and/or lower GI endoscopy between January 2018 and December 2022 at Bolu Abant İzzet Baysal University Faculty of Medicine Hospital Internal Medicine Gastroenterology Outpatient Clinic were included in our study. Patients with liver cirrhosis, advanced chronic renal failure (CRF), GI malignancy, overt upper or lower GI bleeding, previous gastric or small bowel operation, haematological disease, celiac disease, and premenopausal women were excluded from the study. Age, gender, comorbidity, routine medications, blood test results were documented. Cases with iron deficiency were divided into subgroups with and without anaemia according to blood test results and the relation of the parameters with malignancy was evaluated. Results: 367 cases, 190 women and 177 men, were included in our study. GIS malignancy was detected in 20 cases, and non-GI malignancy was detected in 3 cases. The age of those diagnosed with GI malignancy was calculated to be statistically significantly higher. The frequency of GI malignancy was found to be significantly higher in men (8.42%) than in women (2.26%). The frequency of GI malignancy was found to be significantly higher in those with anemia (7.09%, 18/254) than in those without anemia (1.77%, 2/113). The frequency of GI malignancy in cases with a positive fecal occult blood test (FOBt) was significantly higher (11.69%) than in cases with a negative FOBt (2.52%). Conclusions: The results of our study showed that anaemia status, age, gender, and the result of the FOBt were important factors in terms of the risk of GI malignancy. Therefore, we think that age, gender, whether has anaemia or not, and the result of FOBt should be taken into consideration in addition to family history and alarm symptoms in determining the urgency status of patients with iron deficiency for endoscopic evaluation. KEYWORDS: Iron Deficiency, Iron Deficiency Anaemia, Endoscopy, Gastrointestinal Malignancy