Screening for gastrointestinal malignancy in patients with iron deficiency anemia by general practitioners: an observational study

Scand J Gastroenterol. 2011 Sep;46(9):1105-10. doi: 10.3109/00365521.2011.594082. Epub 2011 Jul 4.


Background: The prevalence of iron deficiency anemia (IDA) is 2-5% in men and postmenopausal women in the developed world. IDA is commonly caused by chronic gastrointestinal blood loss, and a thorough examination of the gastrointestinal tract must be standard practice.

Objective: To retrospectively study endoscopic evaluations of patients from general practitioners diagnosed with IDA in a peripheral hospital laboratory in order to determine the cause of IDA and the number of gastrointestinal malignancies.

Material and methods: We retrospectively evaluated all patients with IDA diagnosed in a peripheral hospital laboratory by the general practitioner in the region of our hospital from 1 January 2004 until 31 December 2005. We included women older than 50 and men 18 years and older without a history of IDA in the previous 2 years.

Results: In 2 years, 287 patients were newly diagnosed with IDA in our hospital laboratory. Only 90 (31%) patients were endoscopically evaluated within 4 months. Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 41 of 90 (46%) patients. The most common lesions identified by gastroduodenal endoscopy were erosive esophagitis, gastritis and duodenitis (14%). Cancer was the most commonly detected lesion in the colon, accounting for 17 of 21 colonic lesions explaining IDA. In total, gastrointestinal malignancy was diagnosed in 2% of screened patients. Factors determining the decision for endoscopic screening were lower hemoglobin level, lower ferritin level and male gender.

Conclusion: In our retrospective study of patients with IDA, only 31% received any form of endoscopic evaluation. In general practice, IDA is investigated suboptimally, and interventions other than the issuing of guidelines are needed to change practice.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia, Iron-Deficiency / etiology*
  • Carcinoma / complications*
  • Carcinoma / diagnosis*
  • Colonic Neoplasms / complications
  • Colonic Neoplasms / diagnosis*
  • Duodenitis / complications
  • Endoscopy, Gastrointestinal
  • Esophageal Neoplasms / complications
  • Esophageal Neoplasms / diagnosis*
  • Esophagitis / complications
  • Female
  • Gastritis / complications
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / etiology*
  • Guideline Adherence
  • Hemoglobins / metabolism
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Netherlands
  • Practice Guidelines as Topic
  • Referral and Consultation
  • Retrospective Studies
  • Sex Factors
  • Stomach Neoplasms / complications
  • Stomach Neoplasms / diagnosis*
  • Young Adult


  • Hemoglobins