AGA Publishes Guideline on Screening Patients With Iron Deficiency Anemia for GI Causes

The American Gastroenterological Association (AGA) has developed a new clinical guideline¹ that calls for screening patients with chronic iron deficiency anemia (IDA) that has no obvious etiology for possible gastrointestinal causes.

“Iron deficiency anemia is encountered commonly in clinical practice, yet there is significant practice variability among physicians evaluating these patients,” said Cynthia W. Ko, lead guideline author from University of Washington School of Medicine, Seattle, in a press release.² “We’re pleased to introduce this guideline, which will walk gastroenterologists through the recommended management of these patients to ensure we find and address early any underlying risk of serious diseases and provide the best possible outcomes for our patients.”

The guideline was developed to provide an evidence-based approach to evaluating asymptomatic patients for chronic IDA, which is a very common condition worldwide. It is estimated that in the United States, 12% of women aged 12 to 49 years, 9% of women aged 50 to 69 years, and 2% of men aged 16 to 69 years are iron deficient.

While chronic IDA can be caused by inadequate nutrition, poor absorption of iron, or chronic blood loss, this condition often results from chronic occult gastrointestinal bleeding in adult men and postmenopausal women. The most serious potential cause is gastrointestinal malignancy. Other gastrointestinal conditions that can result in iron deficiency include peptic ulcer disease, celiac disease, inflammatory bowel disease, and other diseases that can create lesions in the gastrointestinal tract.

The guideline includes a strong recommendation that gastroenterologists perform bidirectional endoscopy on men and postmenopausal women without clear symptoms that explain their anemia. For premenopausal women, the AGA issued a conditional recommendation for bidirectional endoscopy.

Prior to endoscopy, the AGA recommends that asymptomatic patients receive noninvasive testing for celiac disease and for the presence of Helicobacter pylori. In cases in which patients have symptoms of gastrointestinal disease or disorder, the guideline authors recommend that upper endoscopy and colonoscopy be performed at the same visit.

The AGA does not recommend gastric or duodenal biopsies if noninvasive tests are negative.

—Rebecca Mashaw

References:

1. Ko Cw, Siddique SM, Patel A, et al. AGA clinical practice guidelines on gastrointestinal evaluation of iron deficiency anemia. Gastroenterology. Published online August 15, 2020. https://doi.org/10.1053/j.gastro.2020.06.046
2. AGA recommends bidirectional endoscopy for most patients with iron deficiency anemia. News release. American Gastroenterological Association; August 25, 2020. Accessed August 26, 2020.