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World J Gastroenterol. Oct 7, 2009; 15(37): 4638-4643
Published online Oct 7, 2009. doi: 10.3748/wjg.15.4638
A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases
Fernando Bermejo, Santiago García-López
Fernando Bermejo, Digestive Service, University Hospital of Fuenlabrada, Fuenlabrada, Madrid 28942, Spain
Santiago García-López, Digestive Service, University Hospital Miguel Servet, Zaragoza 50009, Spain
Author contributions: Bermejo F and García-López S contributed equally to this work.
Correspondence to: Fernando Bermejo, MD, PhD, Digestive Service, University Hospital of Fuenlabrada, Fuenlabrada, Madrid 28942, Spain. fbermejos@medynet.com
Telephone: +34-91-6006175 Fax: +34-91-6006175
Received: July 23, 2009
Revised: August 24, 2009
Accepted: August 31, 2009
Published online: October 7, 2009
Abstract

Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by enteroscopy.

Keywords: Anemia; Iron-deficiency; Iron deficiency anemia