Upper Endoscopy Helps Identify Cause of Iron Deficiency Anemia in Children

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New results from a recent retrospective study indicate the positive diagnostic yield of upper endoscopy in children with severe, unexplained iron deficiency anemia.¹

According to the analysis, presented at United European Gastroenterology Week 2023 in Copenhagen, Denmark, upper endoscopy allowed for the identification of the cause of iron deficiency anemia in ≥70% of children in the study.

“Upper endoscopy should be included in the diagnostic investigation of severe unexplained iron deficiency anemia in children,” wrote the investigative team, led by N. Yuran of the department of pediatrics, Kaplan Medical Center.

Approximately 2 billion people globally are affected by iron deficiency anemia.² Among children in developed countries, the prevalence of iron deficiency in children ≤4 years is estimated to be 20.1%, while the rate increases to 39% in developing countries. If clinically suspected, laboratory evaluation can confirm the presence of iron deficiency anemia, as well as be used for follow-up care.

Often, iron deficiency can go underrecognized until a patient reaches severely low hemoglobin levels. A delay in diagnosis could increase the risk for rare, serious complications, including thrombosis stroke, congestive heart failure, neurodevelopmental outcomes, and even death. However, Yuran and colleagues indicated the lack of established guidelines for the diagnostic workup and management of severe iron deficiency anemia.¹

In this analysis, the investigative team aimed to assess the diagnostic yield of upper endoscopy in children with severe, unexplained iron deficiency anemia, without gastrointestinal bleeding, in regard to their management and outcomes. They performed a retrospective study of children <18 years hospitalized with hemoglobin <7 gr/dL, who underwent upper endoscopy between 2016 and 2022.

The investigative team collected baseline data on demographics, symptoms, laboratory results, endoscopic/histopathological findings, and treatment. They also identified follow-up data, including hemoglobin at 6 months and the need for repeat iron treatment. A total of 25 children with severe iron deficiency were evaluated for the analysis. Participants had a mean age of 10.7 years, 19 (76%) were female, and 8 (32%) were of Ethiopian origin.

Upon analysis, investigators found the symptoms of anemia were present in 19 of 25 (76%) children, and gastrointestinal symptoms were present in 10 of 25 (40%) children. The mean hemoglobin level was 6.2 gr/dL (range, 3.2 - 6.9).

The initial treatment included blood transfusion in 3 (12%) patients, intravenous iron infusions in 21 (84%) patients, and oral iron in 1 (4%) patient. Endoscopic findings revealed gastro nodularity, erosions, or polyps in 17 of 25 (68%) individuals and duodenitis/ulcers in 3 of 25 (12%) participants.

Moreover, histopathology showed gastritis in 18 of 25 (72%) children and Helicobacter pylori in 9 of 18 (50%) children. Additionally, 5 children had collagenous gastritis, 1 had lymphocytic, and 3 had non-specific gastritis. Three children had nonspecific duodenitis and 1 had celiac disease.

The study found an etiology of iron deficiency anemia in 18 of 25 (72%) children and 15 without gastrointestinal symptoms. Over the follow-up period, hemoglobin levels were noted to have remained stable in 23 of 25 (92%) children, with only 2 requiring repeat iron therapy.

“[Upper endoscopy] enabled to identify the cause of iron deficiency anemia in over 70% of children,” investigators wrote.

References

1. _{M. Kori, N. Yuran, T. Ben-Ami. High Diagnostic Yield of Upper Endoscopy in Children with Severe Iron Deficiency Anemia of Unexplained Cause. Data presented at United European Gastroenterology Week 2023. Copenhan, Denmark. October 14 – 17, 2023. https://ueg.eu/week}
2. _{Martinez-Torres V, Torres N, Davis JA, Corrales-Medina FF. Anemia and Associated Risk Factors in Pediatric Patients. Pediatric Health Med Ther. 2023;14:267-280. Published 2023 Sep 4. doi:10.2147/PHMT.S389105}