Gastrointestinal Evaluation of Iron Deficiency Anemia

Iron deficiency anaemia is a global health concern arising when iron loss or inadequate intake fails to meet the demands of erythropoiesis, leading to reduced haemoglobin levels and microcytic anaemia. While dietary insufficiency and menstruation are common in younger populations, occult gastrointestinal blood loss is a leading cause in adults, particularly in men and post-menopausal women. Initial laboratory assessment includes measurement of haemoglobin, ferritin, transferrin saturation and mean corpuscular volume to confirm iron deficiency. Once laboratory indices indicate iron deficiency, guidelines recommend bidirectional endoscopy—combining oesophagogastroduodenoscopy and colonoscopy—as first-line investigation to detect mucosal lesions, neoplasia or vascular malformations. In cases of negative standard endoscopy or ongoing anaemia, adjunctive modalities such as capsule endoscopy, computed tomography enterography or repeat endoscopic evaluation may be employed. Recent advances emphasise a risk-stratified approach, integrating clinical predictors like age, severity of anaemia and positive faecal occult blood tests to prioritise investigation pathways. A multidisciplinary team involving haematologists, gastroenterologists and primary care physicians is essential to ensure timely diagnosis, optimise iron repletion strategies and reduce the morbidity associated with delayed detection of gastrointestinal pathology.

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Gastrointestinal Evaluation of Iron Deficiency Anemia publication trend

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Technical terms

Iron deficiency anaemia: A condition characterised by reduced haemoglobin concentration due to insufficient iron for red blood cell production.

Bidirectional endoscopy: The combined use of oesophagogastroduodenoscopy and colonoscopy to examine both the upper and lower gastrointestinal tract.

Ferritin: An intracellular protein that stores iron and serves as a marker of total body iron reserves.

Transferrin saturation: The percentage of transferrin binding sites occupied by iron, reflecting iron availability for erythropoiesis.

Mean corpuscular volume (MCV): The average volume of individual red blood cells, used to classify anaemia as microcytic, normocytic or macrocytic.

Faecal occult blood test (FOBT): A non-invasive assay that detects hidden blood in stool, screening for gastrointestinal bleeding.

References

1. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterology (2008).
2. Testing Practices, Interpretation, and Diagnostic Evaluation of Iron Deficiency Anemia by US Primary Care Physicians. JAMA Network Open (2021).
3. Association between iron deficiency anemia and subsequent stomach and colorectal cancer diagnosis in Germany. Journal of Cancer Research and Clinical Oncology (2024).