AGA recommends bidirectional endoscopy to evaluate iron deficiency anemia
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The American Gastroenterological Association recently published clinical guidelines for gastrointestinal evaluation of iron deficiency anemia in Gastroenterology.
“These practice recommendations for the initial gastro-intestinal evaluation of [iron deficiency anemia (IDA)] were developed using the GRADE framework, with the goal of promoting high-quality and high-value care,” Cynthia W. Ko, MD, from the division of gastroenterology at the University of Washington School of Medicine in Seattle and colleagues wrote. “IDA is extremely common worldwide, and a gastrointestinal cause should be considered in all patients without an obvious etiology.”
Ko and colleagues used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology and best practices highlighted by the National Academy of Medicine to create the guidelines. The recommendations were based on consensus between the Guideline panel members.
AGA recommendations for evaluation of iron deficiency anemia include:
- In patients with anemia, there should be a cutoff of 45 ng/mL over 15 ng/mL when ferritin is used to diagnose iron deficiency;
- Clinicians should carefully document the presence of iron deficiency and anemia before endoscopic evaluation;
- Gastroenterologists should perform bidirectional endoscopy on asymptomatic men and postmenopausal women with iron deficiency anemia. The same should be performed in premenopausal women vs. iron replacement therapy;
- Non-invasive testing should be performed for Helicobacter pylori and celiac disease in asymptomatic patients with iron deficiency anemia before bidirectional endoscopy. If the test is positive, begin treatment. If tests are negative, routine gastric or duodenal biopsies should not be performed; and
- A trial of initial iron supplementation should be used over routine use of video capsule endoscopy in complicated asymptomatic patients with iron deficiency anemia and negative bidirectional endoscopy.
Perspective
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Christine Lee, MD
Iron deficiency is a very common cause of anemia and the wide range of iron deficiency anemia etiology includes suboptimal oral intake, poor absorption of oral iron, chronic blood loss from gastrointestinal and other sources, peptic ulcer disease, celiac disease, inflammatory bowel disease, fad diets, poly-pharmacy, co-morbidities and more. The AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia can help systematize the initial approach to gastrointestinal evaluation of iron deficiency anemia. The GRADE framework outlines recommendations based on the strength of the available evidence, which allows delivery of more clinically sound, evidence-based care tailored to the specifics of the patient.
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