Enteroscopic Study for Evaluation of Small Intestinal Lesions in Patients with Unexplained Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. It is widely accepted that chronic occult blood loss from the gastrointestinal tract is a major cause of IDA. This study aimed to evaluate small intestinal lesions in patients with unexplained iron deficiency anemia, with or without fecal occult blood by enteroscopy and to elucidate the pathologic nature of small intestinal mucosal abnormalities for iron deficiency anemia. Methods: This study included 40 subjects; 10 non-anemic patients but suffering from GIT symptoms needed to be investigated by enteroscopy as a control group and 30 patients with unexplained iron deficiency anemia (without any bleeding sources detected by upper and lower gastrointestinal endoscopy). Complete blood count, iron status, and fecal occult blood test were measured. The small intestine was evaluated by push enteroscopy and histopathological examination for duodenum and jejunum mucosal biopsies was done. Results: Enteroscopic findings in IDA patients revealed that arteriovenous malformations were detected in 43.3%, jejunal varices in 6.7%, 3rd duodenal mass (tumor) in 3.3% and non-specific jejunal inflammation in 3.3%. There were moderate to severe lamina propria inflammation in all IDA patients that was significantly different from the control group. Logistic regression analysis showed that IDA was related to body mass index, enteroscopic and histopathologic lesions. Conclusions: Subjects with iron deficiency anemia after negative workup on the bleeding sources by conventional upper and lower endoscopies should undergo a further investigation of the small intestine by enteroscopic study, irrespective of their fecal occult blood status.