Original Article
Evaluation of the Gastrointestinal Tract in Patients with Iron-Deficiency Anemia
N Engl J Med 1993; 329:1691-1695December 2, 1993
- Abstract
Background
Idiopathic iron-deficiency anemia in adults is assumed to be the result of occult chronic blood loss from the gastrointestinal tract. The aim of this study was to determine an effective clinical strategy for managing this common clinical problem.
Methods
We prospectively studied 100 consecutive patients with iron-deficiency anemia, using colonoscopy and esophagogastroduodenoscopy and, in patients with negative endoscopic studies, enteroclysis (radiographic examination of the small intestine).
Results
Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 62 of the 100 patients. Endoscopic examination of the upper gastrointestinal tract showed a bleeding source in 36 patients, and colonoscopy showed a lesion in 25; 1 patient had lesions in both the upper and lower gastrointestinal tracts. The most common abnormality in the upper gastrointestinal tract was peptic ulceration (duodenal ulcer in 11 patients, gastric ulcer in 5, and anastomotic ulcer in 3). Cancers, detected in 11 patients, were the most common colonic lesions. Enteroclysis was performed in 26 of the 38 patients with negative endoscopic studies, and the results were normal in all instances. Symptoms at a specific site in the gastrointestinal tract were predictive of disease in the corresponding portion of the bowel. In addition, the combination of positive tests for fecal occult blood and symptoms in the lower gastrointestinal tract had a positive predictive value of 86 percent for detecting a lesion in the lower gastrointestinal tract.
Conclusions
Gastrointestinal lesions (in both the upper gastrointestinal tract and the colon) are frequently found in patients with iron-deficiency anemia. Since site-specific symptoms are predictive of abnormalities in the corresponding portion of the bowel, the initial evaluation should be directed by the location of the symptoms. Concomitant lesions of the upper and lower gastrointestinal tract are rare; thus, detection of a likely source of blood loss during the initial examination may obviate the need for further procedures.
Media in This Article
Table 1
Results of Laboratory Tests in 100 Patients with Iron-Deficiency Anemia.Table 2
Endoscopic Findings in 100 Patients with Iron-Deficiency Anemia.Article Activity
- Article
Occult bleeding from the gastrointestinal tract is widely believed to be the most common cause of iron-deficiency anemia in patients without an obvious source of blood loss. A thorough examination of the gastrointestinal tract, particularly the colon, has therefore become standard practice1,2. Indeed, many clinicians advocate colonoscopy or barium-enema radiography regardless of signs or symptoms of disease in the upper gastrointestinal tract. Previous studies of patients with iron-deficiency anemia were performed in nonhomogeneous populations with an assortment of radiographic and endoscopic techniques, resulting in a variety of recommendations for evaluating such patients3-10. In addition, the usefulness of examining the small bowel is unclear. Our study was designed to determine the diagnostic value of a thorough gastrointestinal evaluation in patients with idiopathic iron-deficiency anemia and to identify clinical features that may predict the likelihood of detecting a gastrointestinal lesion.
Methods
All patients with suspected iron-deficiency anemia who were referred to the gastroenterology service from June 1990 through November 1992 were prospectively screened for enrollment in the study. Iron-deficiency anemia was defined as a hemoglobin concentration ≤ 12.5 g per deciliter (7.8 mmol per liter) for men (normal range, 13.5 to 17.5 [8.4 to 10.9]) and ≤ 10.6 g per deciliter (6.6 mmol per liter) for women (normal range, 11.6 to 15.8 [7.2 to 9.8]), accompanied by at least one of the following laboratory values consistent with iron deficiency: a serum iron concentration ≤ 45 μg per deciliter (8.1 μmol per liter; normal range, 50 to 150 [9.0 to 27.0]) with a transferrin saturation no higher than 10 percent (normal range, 16 to 60 percent), a serum ferritin concentration ≤ 20 μg per liter for men (normal range, 20 to 450) and ≤ 10 μg per liter for women (normal range, 10 to 250), or the absence of iron stores in bone marrow-biopsy specimens. The criteria for excluding patients from the study were an obvious cause of blood loss (e.g., epistaxis or heavy menstrual flow), active gastrointestinal hemorrhage, severe cardiopulmonary disease, a serum transferrin concentration ≤ 2.16 g per liter (normal range, 2.16 to 3.99), reported or suspected pica, age under 18 years, and an inability to give informed consent for endoscopy.
During the study period, 163 patients were referred to the gastroenterology service for evaluation of purported iron-deficiency anemia. Thirty patients were ineligible for the study because they did not meet the criteria for iron-deficiency anemia. Another 33 patients were ineligible for the following reasons. Iron studies were not completed in 11 patients who had been referred for suspected iron-deficiency anemia on the basis of red-cell indexes: 4 patients began iron therapy before the blood tests were performed, 3 had tests only for serum iron, 2 were lost to follow-up, and 2 declined further blood studies. Sixteen patients were excluded because their serum transferrin values were less than or equal to 2.16 g per liter, suggesting that they had anemia associated with chronic disease. Six patients with documented iron-deficiency anemia were excluded because they were unable to give informed consent (two patients), had an obvious nongastrointestinal source of blood loss (two patients), or had unstable cardiovascular status (two patients).
Detailed clinical data were obtained for all patients enrolled in the study, with an emphasis on gastrointestinal symptoms. The specific symptoms of the upper gastrointestinal tract that patients were asked about included dysphagia, odynophagia, heartburn, dyspepsia, nausea, vomiting, anorexia, and upper abdominal pain related to eating or relieved by antacids. The specific lower gastrointestinal symptoms inquired about included hematochezia, a change in bowel habits, diarrhea, constipation, and lower abdominal pain that was colicky or changed with the passage of stool. Patients were also asked about the use of aspirin, other nonsteroidal antiinflammatory drugs, and alcohol. Before the endoscopic evaluation was performed, stool samples obtained by the patient or by digital rectal examination were tested for occult blood with the use of Hemoccult II slides (SmithKline, Sunnyvale, Calif.).
Patients were sedated for sequential endoscopic procedures with intravenous midazolam, meperidine, or both, while vital signs and oxygen saturation were monitored and electrocardiography was performed. The colonoscopy was performed first, followed immediately by esophagogastroduodenoscopy with the same anesthetic. The cecum was reached in all patients. There were no complications of the endoscopic procedures. If both upper and lower endoscopic examinations were negative, patients were referred to the radiology department for enteroclysis, which was performed by fluoroscopic intubation of the duodenum and instillation of barium and methylcellulose into the small intestine11.
For the colonoscopic examination, the following lesions were judged to be sources of substantial occult blood loss: a carcinoma, one or more adenomatous polyps over 1.5 cm in diameter, vascular ectasias that numbered five or more or were at least 8 mm in diameter, active colitis, or a colonic ulcer more than 1 cm in diameter. Diverticula were judged not to be a source of chronic blood loss. For the endoscopic examination of the upper gastrointestinal tract, the lesions considered to be sources of blood loss included esophagitis with erosions involving at least 5 percent of the mucosal surface of the esophagus,12 erosive gastritis (defined as at least 50 erosions of 1 mm or more with white bases encircled by erythema),13 a duodenal or gastric ulcer more than 1 cm in diameter, a carcinoma, adenomatous polyps, and vascular ectasias (the last two as described above). Hiatal hernias and esophageal varices were not considered to be causes of chronic blood loss. In the patients undergoing enteroclysis, mass lesions more than 1 cm in diameter, ulcerations, and extensive mucosal inflammatory changes were judged to be probable sources of blood loss. Endoscopic evidence of bleeding was noted, including hemorrhagic mucosa and a visible vessel in an ulcer.
Statistical analyses were performed with SAS software14,15. The upper confidence limit for a binomial parameter was computed exactly16.
Results
Clinical Features
The study group consisted of 73 outpatients and 27 inpatients, 51 of whom were women. The mean (±SD) age was 60 ±14 years, with a range of 20 to 85 years. Nine women were menstruating; none had a history of unusual or heavy flow. All the patients were anemic, with serum ferritin levels or transferrin-saturation values that were consistent with iron deficiency (Table 1Table 1
Results of Laboratory Tests in 100 Patients with Iron-Deficiency Anemia.). Bone marrow-biopsy specimens from two patients had no stainable iron.In 22 patients the presenting symptoms (e.g., fatigue and shortness of breath) were related to end-organ compromise. Thirty-three patients had the following concomitant medical illnesses: organic heart disease (13 patients), chronic liver disease (8 patients), chronic renal disease (4 patients), nongastrointestinal cancer (4 patients), rheumatologic disorders (3 patients), and miscellaneous disorders (4 patients). Three patients had two illnesses each.
Endoscopic Findings
A substantial gastrointestinal lesion was detected in 62 of the 100 patients (Table 2Table 2
Endoscopic Findings in 100 Patients with Iron-Deficiency Anemia.). Colonoscopy revealed a likely bleeding site in 25 patients, whereas esophagogastroduodenoscopy demonstrated a lesion in 36 patients; 1 patient had both a gastric and a colonic lesion. Cancer was the most common lesion in the colon, accounting for 11 (8 in the right colon and 3 in the left) of the 26 colonic lesions (42 percent). Three patients had Dukes class B cancers, three had Dukes class D, and five had Dukes class C17. All the colon cancers were ulcerated. Five patients with cancer had symptoms. Among the 10 patients with colon cancer who had valid stool guaiac tests (see below), 8 had positive tests. Only one patient with colon cancer both was asymptomatic and had a negative test for occult blood. Of the five patients with vascular ectasias (three cecal and two left colonic), four had multiple lesions; all five patients were treated endoscopically. Of the two patients with colitis, one had radiation colitis, and the other idiopathic ulcerative colitis. One of the cecal ulcers was idiopathic, and one was tuberculous. Fifteen patients with colonic lesions had stigmata of recent bleeding (11 of the 15 had cancer, and 1 each had vascular ectasia, tuberculous cecal ulceration, radiation colitis, and a polyp).Peptic ulceration (of the duodenum, stomach, or gastroduodenal anastomosis) was the most common lesion identified in the upper gastrointestinal tract, accounting for 19 of 37 lesions (51 percent) (Table 2). Six patients had giant ulcers (>2 cm in diameter): five had duodenal ulcers, and one had a gastric ulcer. Five patients had previously undergone a partial gastrectomy with Billroth II anastomoses, and four of the five had associated abnormalities (anastomotic ulcers in three patients and severe gastritis in one). None of the patients had an actively bleeding ulcer; one visible vessel in a giant duodenal ulcer was treated endoscopically. Two patients with gastritis were taking nonsteroidal antiinflammatory drugs: one had a Billroth II anastomosis, and one had chronic liver disease. Four of the six patients with esophagitis had severe inflammation with extensive erosions and ulceration. Three patients had multiple vascular ectasias (gastric in two patients and proximal duodenal in one); all were treated endoscopically. The patient with gastric cancer had a stage T3N2M0 tumor18. Nine patients had stigmata of recent bleeding (four had severe esophagitis and one each had a duodenal ulcer with a visible vessel, vascular ectasia, gastritis, portal hypertensive gastropathy, and a gastric polyp).
Thirteen patients had unexplained weight loss: seven with upper gastrointestinal abnormalities, four with cancer of the right colon, and two with no lesions. The mean weight loss was 13 kg (range, 2 to 36), 12 kg (range, 2 to 18), and 7 kg (range, 2 to 12) in those with upper gastrointestinal lesions, colon cancer, and no lesions, respectively.
Twenty-one patients reported long-term use of substances that irritate the gastrointestinal mucosa, including nonsteroidal antiinflammatory drugs other than aspirin (11 patients), aspirin (4 patients, none of whom took more than 325 mg per day), and alcohol (6 patients). Seven of the patients taking nonsteroidal antiinflammatory drugs had no identifiable lesions, two had lesions in the upper gastrointestinal tract (gastritis in both cases), and two had lesions in the lower gastrointestinal tract. One patient taking aspirin had colon cancer, and three had no detectable lesions. Of the six patients who drank alcohol regularly, three had lesions in the upper gastrointestinal tract (esophagitis, vascular ectasia, and duodenal ulcer in one each), and three had no lesions.
Radiographic Findings
Thirty-eight patients with negative endoscopic examinations of the upper and lower gastrointestinal tract were referred to the radiology service for enteroclysis. Twenty-six underwent this examination, and three additional patients underwent a small-bowel follow-through study after swallowing barium (because of difficulty with insertion of the enteroclysis perfusion tube). No lesions were identified in any of these patients.
Statistical Analysis
Values for hemoglobin, mean corpuscular volume, serum ferritin, and transferrin saturation did not differ significantly between patients with positive endoscopic studies and those with negative endoscopic studies.
Site-specific symptoms were significantly associated with lesions in the portion of the gastrointestinal tract where the symptoms originated, and these symptoms were predictive of abnormal findings (Table 3Table 3
Relation of Lesion Site to Location of Symptoms and Results of Fecal Occult-Blood Tests. and Table 4Table 4
Association of Site-Specific Symptoms and Fecal Occult Blood with Gastrointestinal Lesions.). Although site-specific symptoms were strongly associated with site-specific lesions, the absence of symptoms did not exclude the possibility of detecting a lesion. For the statistical analysis, a valid test for fecal occult blood was defined as at least one positive test or at least three negative tests; 90 patients had valid tests for stool blood. Stool testing alone had a relatively low sensitivity for detecting disease and a positive predictive value of 75 percent overall. Among patients with site-specific symptoms and positive tests for fecal occult blood, the positive predictive value for detecting lesions in the lower and upper gastrointestinal tracts increased to 86 percent and 82 percent, respectively.No clinical feature distinguished patients with colon cancer from those with other colonic lesions. The 95 percent confidence limit for detecting colon cancer in a patient who had an upper gastrointestinal lesion was 0.08. This computation assumes that all patients with iron-deficiency anemia have an equal (i.e., high) risk of colon cancer. However, since some patients (such as those who are young and those with symptoms and lesions in the upper gastrointestinal tract) may be at lower risk for colon cancer, our confidence limit may be falsely high. No patient with a lesion in the upper gastrointestinal tract had colon cancer.
Patients with Negative Endoscopic and Radiographic Studies
Lesions considered unlikely to be responsible for chronic blood loss in the 38 patients with negative endoscopic and radiographic studies included small polyps (1 cm in 1 patient, 0.5 cm in 1 patient, and less than 4 mm in 4 patients), hemorrhoids alone in 4 patients, antral hyperemia in 3 patients, small esophageal varices in 2 patients, and minimal esophagitis in 1 patient. No stigmata of bleeding were identified in connection with any of these lesions.
All 38 patients were empirically treated with oral iron; 36 of them were seen for follow-up tests 6 to 38 months later (mean, 20 months). Iron-deficiency anemia had resolved (defined as an increase in hemoglobin above the lower limit of normal) in 30 of the 36 patients (83 percent). All six patients in whom iron therapy was not effective had underlying medical illnesses. Three of the six patients had severe chronic renal insufficiency: two underwent long-term dialysis, and the third had an episode of melena but declined evaluation. Of the three other patients who did not have a response to iron therapy, one subsequently presented with calcinosis, Raynaud's phenomenon, esophageal hypomotility, sclerodactyly, and telangiectasia (CREST syndrome) and reported recurrent epistaxis; one had multiple medical problems, including chronic liver disease; and one with degenerative joint disease later reported having taken nonsteroidal antiinflammatory drugs, and a repeat esophagogastroduodenoscopy showed severe gastritis. Two patients died: one from chronic renal failure and the other (who had responded to iron therapy) from chronic liver disease.
Discussion
Idiopathic iron-deficiency anemia in adults is widely believed to result from chronic colonic blood loss due to mass lesions1,2. However, there are no study-based guidelines for efficiently managing this disorder. In an attempt to establish such guidelines, we prospectively studied 100 patients with iron-deficiency anemia, using upper gastrointestinal endoscopy and colonoscopy followed by small-bowel enteroclysis. We identified lesions consistent with chronic blood loss in 62 of the 100 patients. Although colorectal cancers were found in 11 patients, more lesions were detected in the upper gastrointestinal tract.
Symptoms that could be traced to either the upper or lower gastrointestinal tract were strongly associated with identification of a lesion by esophagogastroduodenoscopy or colonoscopy, respectively. Furthermore, the combination of a positive test for fecal occult blood and site-specific gastrointestinal symptoms increased the likelihood of detecting a bleeding source in the corresponding site. These results strongly suggest that for iron-deficient patients with specific symptoms, the initial examination should be directed by those symptoms. However, asymptomatic patients, particularly those who are elderly, since they have an increased risk of colorectal neoplasia,19 should undergo colonoscopy, followed immediately by an endoscopic examination of the upper gastrointestinal tract if the colonoscopic examination is negative.
For patients in whom a substantial upper gastrointestinal lesion (according to our criteria) has been detected by esophagogastroduodenoscopy, the decision to examine the lower gastrointestinal tract may be controversial. Our data suggest that a synchronous lesion is unlikely. Clinicians may therefore reasonably elect not to undertake a colonic evaluation if a lesion has been detected in the upper gastrointestinal tract. This approach should limit the costs and potential risks of additional studies. Clinical judgment and follow-up, however, are essential. For example, since most of the substantial lesions of the upper gastrointestinal tract are related to acid-peptic disease, an intensive course of anti-acid therapy and iron replacement can be expected to correct the anemia. If the anemia does not resolve or if it returns after therapy has been discontinued, then a reevaluation, including a colonic examination, is recommended.
Nonsteroidal antiinflammatory drugs and alcohol have been associated with acute and chronic injury of the upper gastrointestinal mucosa20-24. We were unable, however, to find any correlation between the use of these irritants and lesions in the upper gastrointestinal tract. The patients who were taking nonsteroidal antiinflammatory drugs may have had ulcers that had healed by the time of our investigation, or the drugs may have induced small gastric or small-bowel lesions that were not detected by endoscopy.
Chronic blood loss from the distal small bowel may be responsible for iron-deficiency anemia1,2,25. Enteroclysis theoretically should reveal substantial mass lesions or severe ulcerative processes but not subtle mucosal abnormalities. In this regard, we may have failed to identify vascular ectasias or subtle abnormalities of the small-bowel mucosa. Although it is possible that some of our patients had occult small-bowel disorders, such as adult celiac disease or Whipple's disease, that were not detected, this possibility seems unlikely. No patients had symptoms of malabsorption, and the majority of patients with negative studies had a response to oral iron therapy. The role of enteroscopy in identifying abnormalities in the small bowel is controversial26. Vascular ectasias and other subtle mucosal lesions have occasionally been detected by this procedure in patients with occult gastrointestinal bleeding or iron-deficiency anemia27,28. Although theoretically appealing, small-bowel enteroscopy is expensive and time consuming, requires special equipment, and has not been rigorously studied.
Over one third of the patients in our study had no lesions compatible with gastrointestinal bleeding. Follow-up data in these patients suggested a favorable prognosis, and the subsequent discovery of gastrointestinal tract lesions was rare. Most of these patients were asymptomatic. Conditions such as unreported menstrual losses (potentially in three patients in our study) or insufficient dietary intake of iron may have been responsible for occult iron deficiency. Alternatively, ulcerations or benign lesions may have caused blood loss in the past but then healed and thus were not detected. Although less likely, small ulcers or polyps may have led to chronic bleeding. Finally, abnormalities such as polyps or vascular ectasias may have been missed during the endoscopic examination. All the patients with persistent anemia had serious underlying medical illnesses, which is consistent with the possibility that their anemia was associated with chronic disease.
We conclude that substantial gastrointestinal lesions, particularly those of the upper gastrointestinal tract, are common in patients with iron-deficiency anemia. Therefore, a thorough evaluation of all such patients is mandatory. Many patients believed at first to be iron-deficient may not have decreased iron stores, and careful screening is therefore important before potentially expensive and unproductive studies are undertaken. We believe that the initial investigation should be directed toward site-specific symptoms. In asymptomatic older patients, the colon should be examined first. Patients with negative colonic studies should then undergo an upper gastrointestinal evaluation. Since synchronous lesions of the upper and lower gastrointestinal tract are rare, once an obvious source of potential blood loss has been identified, further examination of the gastrointestinal tract (but not further follow-up) appears to be unwarranted.
Presented in part at the annual meeting of the American Gastroenterological Association, San Francisco, May 9-15, 1992.
We are indebted to the nurses, staff, residents, and fellows of the gastrointestinal unit at San Francisco General Hospital for their assistance and support, and to Dr. David Heilbron for performing the statistical calculations.
Source Information
From the Gastroenterology Division, Medicine Service, San Francisco General Hospital, University of California, San Francisco.
Address reprint requests to Dr. Rockey at the Liver Center Laboratory, San Francisco General Hospital, Bldg. 40, Rm. 4102, San Francisco, CA 94110.
- References
References
1
Peterson WL. Gastrointestinal bleeding. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal disease. 4th ed. Vol. 1. Philadelphia: W.B. Saunders, 1989:415-6.
2
Ahlquist DA. Approach to the patient with occult gastrointestinal bleeding. In: Yamada T, ed. Textbook of gastroenterology. Vol. 1. Philadelphia: J.B. Lippincott, 1991:616-33.
3
Kerlin P ,Reiner R ,Davies M ,Sage RE ,Grant AK . Iron deficiency anemia -- a prospective study. Aust N Z J Med 1979;9:402-407
CrossRef | Medline4
Croker JR ,Beynon G . Gastro-intestinal bleeding -- a major cause of iron deficiency in the elderly. Age Ageing 1981;10:40-43
CrossRef | Web of Science | Medline5
Hershko C ,Vitells A ,Braverman DZ . Causes of iron deficiency anemia in an adult inpatient population: effect of diagnostic workup on etiologic distribution. Blut 1984;49:347-352
CrossRef | Medline6
Cook IJ ,Pavli P ,Riley JW ,Goulston KJ ,Dent OF . Gastrointestinal investigation of iron deficiency anaemia. BMJ 1986;292:1380-1382
CrossRef | Web of Science | Medline7
Calvey HD ,Castleden CM . Gastrointestinal investigations for anaemia in the elderly: a prospective study. Age Ageing 1987;16:399-404
CrossRef | Web of Science | Medline8
Wroblewski M ,Ostberg H . Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Scand J Gastroenterol 1990;25:489-495
CrossRef | Web of Science | Medline9
Tan CC ,Guan R ,Tay HH ,Yap I ,Math MV . The diagnostic yield of upper gastrointestinal endoscopy in the investigation of anaemia. Singapore Med J 1991;32:157-159
Medline10
Zuckerman G ,Benitez J . A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol 1992;87:62-66
Web of Science | Medline11
Maglinte DDT ,Lappas JC ,Kelvin FM ,Rex D ,Chernish SM . Small bowel radiography: how, when, and why? Radiology 1987;163:297-305
Web of Science | Medline12
Hetzel DJ ,Dent J ,Reed WD , et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology 1988;95:903-912
Web of Science | Medline13
Sauerbruch T ,Schreiber MA ,Schussler P ,Permanetter W . Endoscopy in the diagnosis of gastritis: diagnostic value of endoscopic criteria in relation to histological diagnosis. Endoscopy 1984;16:101-104
CrossRef | Web of Science | Medline14
SAS/STAT users's guide: version 6. 4th ed. Cary, N.C.: SAS Institute, 1990.
15
SAS language and procedures: introduction, version 6. Cary, N.C.: SAS Institute, 1990.
16
Cox DR. The analysis of binary data. London: Methuen, 1970:43-8.
17
Newland RC ,Chapuis PH ,Pheils MT ,MacPherson JG . The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer 1981;47:1424-1429
CrossRef | Web of Science | Medline18
American Joint Committee on Cancer. Manual for staging of cancer. 3rd ed. Philadelphia: J.B. Lippincott, 1988:69.
19
Schottenfeld D . The epidemiology of cancer: an overview. Cancer 1981;47:Suppl:1095-1108
CrossRef | Web of Science | Medline20
Graham DY ,Smith JL . Gastroduodenal complications of chronic NSAID therapy. Am J Gastroenterol 1988;83:1081-1084
Web of Science | Medline21
Laine L ,Weinstein WM . Histology of alcoholic hemorrhagic “gastritis”: a prospective evaluation. Gastroenterology 1988;94:1254-1262
Web of Science | Medline22
McCarthy DM . Nonsteroidal antiinflammatory drug-induced ulcers: management by traditional therapies. Gastroenterology 1989;96:662-674
Web of Science | Medline23
Fries JF ,Miller SR ,Spitz PW ,Williams CA ,Hubert HB ,Bloch DA . Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use. Gastroenterology 1989;96:Suppl 2:647-655
Web of Science | Medline24
Carson JL ,Strom BL ,Soper KA ,West SL ,Morse ML . The association of nonsteroidal antiinflammatory drugs with upper gastrointestinal tract bleeding. Arch Intern Med 1987;147:85-88
CrossRef | Web of Science | Medline25
Ress AM ,Benacci JC ,Sarr MG . Efficacy of intraoperative enteroscopy in diagnosis and prevention of recurrent, occult gastrointestinal bleeding. Am J Surg 1992;163:94-99
CrossRef | Web of Science | Medline26
Krevsky B . Enteroscopy: exploring the final frontier. Gastroenterology 1991;100:838-839
Medline27
Morris AJ ,Wasson LA ,Mackenzie JF . Small bowel enteroscopy in undiagnosed gastrointestinal blood loss. Gut 1992;33:887-889
CrossRef | Web of Science | Medline28
Foutch PG ,Sawyer R ,Sanowski RA . Push-enteroscopy for diagnosis of patients with gastrointestinal bleeding of obscure origin. Gastrointest Endosc 1990;36:337-341
CrossRef | Web of Science | Medline
- Citing Articles (133)
Citing Articles
1
Grigorios I. Leontiadis, Virender K. Sharma. 2012. Hematemesis, Melena, and Occult Bleeding/Anemia. , 64-71.
CrossRef2
Antonio Cilona, Angelo Zullo, Cesare Hassan, Lorenzo Ridola, Mauro Annese. (2011) Is faecal-immunochemical test useful in patients with iron deficiency anaemia and without overt bleeding?. Digestive and Liver Disease 43:12, 1022-1024
CrossRef3
Ken Liu, Arthur J. Kaffes. (2011) Iron deficiency anaemia. European Journal of Gastroenterology & Hepatology1
CrossRef4
Sant-Rayn Pasricha. (2011) Should we screen for iron deficiency anaemia? A review of the evidence and recent recommendations. Pathology1
CrossRef5
Akil A. Merchant, Cindy N. Roy. (2011) Not so benign haematology: anaemia of the elderly. British Journal of Haematologyno-no
CrossRef6
Yu-Hsi Hsieh, Hwai-Jeng Lin, Kuo-Chih Tseng. (2011) Which should go first during same-day bidirectional endosocopy with propofol sedation?. Journal of Gastroenterology and Hepatology 26:10, 1559-1564
CrossRef7
Jolanda Droogendijk, Ruud Beukers, Paul B. Berendes, Martine G.H.M. Tax, Pieter Sonneveld, Mark-David Levin. (2011) Screening for gastrointestinal malignancy in patients with iron deficiency anemia by general practitioners: An observational study. Scandinavian Journal of Gastroenterology 46:9, 1105-1110
CrossRef8
K. Liu, A. J. Kaffes. (2011) Review article: the diagnosis and investigation of obscure gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 34:4, 416-423
CrossRef9
Rami Abbass, Marc Hopkins, D. Robert Dufour, Jason Schallheim, Oliver J. Szeto, Louis Y. Korman, Richard L. Amdur, Timothy O. Lipman. (2011) Celiac Disease in an Urban VA Population with Iron Deficiency: The Case Against Routine Duodenal Biopsy. Digestive Diseases and Sciences 56:7, 2037-2041
CrossRef10
Nicolas M. Van Mieghem, Rutger-Jan Nuis, Apostolos Tzikas, Nicolo Piazza, Carl Schultz, Patrick W. Serruys, Peter P. de Jaegere. (2011) Prevalence and prognostic implications of baseline anaemia in patients undergoing transcatheter aortic valve implantation. EuroIntervention 7:2, 184-191
CrossRef11
Anthony T. DeBenedet, Sameer D. Saini, Mimi Takami, Laurel R. Fisher. (2011) Do Clinical Characteristics Predict the Presence of Small Bowel Angioectasias on Capsule Endoscopy?. Digestive Diseases and Sciences 56:6, 1776-1781
CrossRef12
Angelo Milano, Chrysanthi Balatsinou, Antonella Filippone, Maria Pia Caldarella, Francesco Laterza, Domenico Lapenna, Sante Donato Pierdomenico, Fabio Pace, Franco Cuccurullo, Matteo Neri. (2011) A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis. Gastrointestinal Endoscopy 73:5, 1002-1008
CrossRef13
Amit Bhasin, Medha Y. Rao. (2011) Characteristics of Anemia in Elderly: A Hospital Based Study in South India. Indian Journal of Hematology and Blood Transfusion 27:1, 26-32
CrossRef14
S. K. P. John, S. George, J. N. Primrose, J. B. J. Fozard. (2011) Symptoms and signs in patients with colorectal cancer. Colorectal Disease 13:1, 17-25
CrossRef15
Gak Won Yun, Young Joon Yang, Ik Chan Song, Keon Uk Park, Seung-Woo Baek, Hwan Jung Yun, Samyong Kim, Deog Yeon Jo, Hyo Jin Lee. (2011) A Prospective Evaluation of Adult Men with Iron-deficiency Anemia in Korea. Internal Medicine 50:13, 1371-1375
CrossRef16
MJ Pippard. 2011. Iron deficiency anemia, anemia of chronic disorders and iron overload. , 173-195.
CrossRef17
L. T. Goodnough, E. Nemeth, T. Ganz. (2010) Detection, evaluation, and management of iron-restricted erythropoiesis. Blood 116:23, 4754-4761
CrossRef18
Arif Yuksel, Levent Kebapcilar, Erkan Erdur, Giray Bozkaya, Ismail Sari, Ahmet Alacacioglu, Ayse Gul Kebapcilar, Gulten Sop. (2010) The Effect of Iron Treatment on Adhesion Molecules in Patients with Iron Deficiency Anemia. Biological Trace Element Research 137:3, 317-323
CrossRef19
J. M. Higgins, L. Mahadevan. (2010) Physiological and pathological population dynamics of circulating human red blood cells. Proceedings of the National Academy of Sciences 107:47, 20587-20592
CrossRef20
Agustín Urrutia, Emilio Sacanella, Jordi Mascaro, Francesc Formiga. (2010) Anemia en el anciano. Revista Española de Geriatría y Gerontología 45:5, 291-297
CrossRef21
Alan E. Mast, Karen S. Schlumpf, David J. Wright, Brian Custer, Bryan Spencer, Edward L. Murphy, Toby L. Simon, . (2010) Demographic correlates of low hemoglobin deferral among prospective whole blood donors. Transfusion 50:8, 1794-1802
CrossRef22
Bagdagul Y. Aksu, Canan Hasbal, Solen Himmetoglu, Yildiz Dincer, Eylem E. Koc, Sami Hatipoglu, Tulay Akcay. (2010) Leukocyte DNA damage in children with iron deficiency anemia: effect of iron supplementation. European Journal of Pediatrics 169:8, 951-956
CrossRef23
Maria Elena Riccioni, Riccardo Urgesi, Cristiano Spada, Rossella Cianci, Giorgio Pelecca, Alessandra Bizzotto, Guido Costamagna. (2010) Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?. Digestive and Liver Disease 42:8, 560-566
CrossRef24
Don C. Rockey. (2010) Occult and obscure gastrointestinal bleeding: causes and clinical management. Nature Reviews Gastroenterology & Hepatology 7:5, 265-279
CrossRef25
Amy Zhu, Marc Kaneshiro, Jonathan D. Kaunitz. (2010) Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective. Digestive Diseases and Sciences 55:3, 548-559
CrossRef26
Melanie Nutter, Diana Dunston, Jonathan Ieyoub, Albert Hart, Jeannie Harper, Mary S. Burke. (2010) A Retrospective Analysis Comparing Small Bowel Follow-Through With Wireless Capsule Endoscopy in the Evaluation of Obscure Gastrointestinal Bleeding. Gastroenterology Nursing 33:4, 298-302
CrossRef27
Jürgen Barnert, Helmut Messmann. (2009) Diagnosis and management of lower gastrointestinal bleeding. Nature Reviews Gastroenterology & Hepatology 6:11, 637-646
CrossRef28
Hardeep Singh, Kuang Daci, Laura A Petersen, Clyde Collins, Nancy J Petersen, Anila Shethia, Hashem B El-Serag. (2009) Missed Opportunities to Initiate Endoscopic Evaluation for Colorectal Cancer Diagnosis. The American Journal of Gastroenterology 104:10, 2543-2554
CrossRef29
Mark T. McLoughlin, Tony C.K. Tham. (2009) Long-term follow-up of patients with iron deficiency anaemia after a negative gastrointestinal evaluation. European Journal of Gastroenterology & Hepatology 21:8, 872-876
CrossRef30
Kristen Robson, Amy Barto, Rebecca F. Liberman. (2009) The Evaluation of Premenopausal Women with Anemia: What Is the Yield of Gastrointestinal Endoscopy?. Digestive Diseases and Sciences 54:8, 1667-1671
CrossRef31
Susan F Clark. (2009) Iron deficiency anemia: diagnosis and management. Current Opinion in Gastroenterology 25:2, 122-128
CrossRef32
Jennifer Urquhart, Glenn Eisen, Douglas O. Faigel, Nora Mattek, Jennifer Holub, David A. Lieberman. (2009) A closer look at same-day bidirectional endoscopy. Gastrointestinal Endoscopy 69:2, 271-277
CrossRef33
Thomas M. Zarchy, Frank Tsai, Emily Ramicone, Linda S. Chan. (2009) A Risk Profile for Advanced Proximal Neoplasms on Diagnostic Colonoscopy. Digestive Diseases and Sciences 54:1, 151-159
CrossRef34
Jong-Ha Yoo, Ho-Young Maeng, Young-Kyu Sun, Young-Ah Kim, Dong-Wook Park, Tae Sung Park, Seung Tae Lee, Jong-Rak Choi. (2009) Oxidative status in iron-deficiency anemia. Journal of Clinical Laboratory Analysis 23:5, 319-323
CrossRef35
Dan Carter, Yaacov Maor, Simon Bar-Meir, Benjamin Avidan. (2008) Prevalence and Predictive Signs for Gastrointestinal Lesions in Premenopausal Women with Iron Deficiency Anemia. Digestive Diseases and Sciences 53:12, 3138-3144
CrossRef36
Nick Powell, Alistair McNair. (2008) Gastrointestinal evaluation of anaemic patients without evidence of iron deficiency. European Journal of Gastroenterology & Hepatology1
CrossRef37
Philip V. Kaye, Klara Garsed, Krish Ragunath, Aida Jawhari, Barbara Pick, John C. Atherton. (2008) The Clinical Utility and Diagnostic Yield of Routine Gastric Biopsies in the Investigation of Iron Deficiency Anemia: A Case-Control Study. The American Journal of Gastroenterology 103:11, 2883-2889
CrossRef38
Emmanuel Andrès, Laure Federici, Khalid Serraj, Georges Kaltenbach. (2008) Update of nutrient-deficiency anemia in elderly patients. European Journal of Internal Medicine 19:7, 488-493
CrossRef39
Kushang V. Patel. (2008) Epidemiology of Anemia in Older Adults. Seminars in Hematology 45:4, 210-217
CrossRef40
L. VANNELLA, M. A. ALOE SPIRITI, G. COZZA, L. TARDELLA, B. MONARCA, A. CUTERI, M. MOSCARINI, G. DELLE FAVE, B. ANNIBALE. (2008) Benefit of concomitant gastrointestinal and gynaecological evaluation in premenopausal women with iron deficiency anaemia. Alimentary Pharmacology & Therapeutics 28:4, 422-430
CrossRef41
Francisco Pérez Roldán, Jesús Javier Castellanos Monedero, Pedro González Carro, María Concepción Villafáñez García, Óscar Roncero García-Escribano, María Luisa Legaz Huidobro, Francisco Ruiz Carrillo. (2008) Efecto de la erradicación de Helicobacter pylori en la anemia ferropénica de origen incierto. Gastroenterología y Hepatología 31:4, 213-216
CrossRef42
Rosanna Sibilla, Maria Giulia Santaguida, Camilla Virili, Lucilla Gargano, Serena Nardo, Michele Della Guardia, Nicola Viceconti, Antonella Franchi, Marco Centanni. (2008) Chronic unexplained anaemia in isolated autoimmune thyroid disease or associated with autoimmune related disorders. Clinical Endocrinology 68:4, 640-645
CrossRef43
A. G. Shaw, J. Simpson, G. Tierney, A. F. Goddard, J. R. Reynolds, J. N. Lund. (2008) Referral of patients with iron deficiency anaemia under the lower gastrointestinal two-week wait rule. Colorectal Disease 10:3, 294-297
CrossRef44
D. J. Unsworth, R. J. Lock, R. F. Harvey. (2008) Improving the diagnosis of coeliac disease in anaemic women. British Journal of Haematology 111:3, 898
CrossRef45
George N. Ioannou, Jeremy Spector, Don C. Rockey. (2007) Predictors of Endoscopic and Laboratory Evaluation of Iron Deficiency Anemia in Hospitalized Patients. Southern Medical Journal 100:10, 976-984
CrossRef46
S. Masson, D. J. Chinn, M. A. Tabaqchali, G. Waddup, A. D. Dwarakanath. (2007) Is anaemia relevant in the referral and diagnosis of colorectal cancer?. Colorectal Disease 9:8, 736-739
CrossRef47
Martin Sedlacek, John M. Gemery, Brian D. Remillard, Ambrose L. Cheung, Arnold S. Bayer. (2007) In Reply. American Journal of Kidney Diseases 50:2, 342-343
CrossRef48
C. Hershko. (2007) I10 Refractory iron deficiency anemia. Blood Reviews 21, S36-S38
CrossRef49
Mehmet Aslan, Mustafa Kosecik, Mehmet Horoz, Sahbettin Selek, Hakim Celik, Ozcan Erel. (2007) Assessment of paraoxonase and arylesterase activities in patients with iron deficiency anemia. Atherosclerosis 191:2, 397-402
CrossRef50
Ronald Concha, Rafael Amaro, Jamie S. Barkin. (2007) Obscure Gastrointestinal Bleeding. Journal of Clinical Gastroenterology 41:3, 242-251
CrossRef51
Sabiha Khalid, Donovan McGrowder, Mike Kemp, Pauline Johnson. (2007) The use of soluble transferin receptor to assess iron deficiency in adults with cystic fibrosis. Clinica Chimica Acta 378:1-2, 194-200
CrossRef52
Sanjiv Mahadeva, Choon-Seng Qua, Wan Yusoff, Wan Sulaiman. (2007) Repeat Endoscopy for Recurrent Iron Deficiency Anemia: An (Un)Expected Finding from Southeast Asia. Digestive Diseases and Sciences 52:2, 523-525
CrossRef53
D. Vucelic, B. Nenadic, P. Pesko, M. Bjelovic, D. Stojakov, P. Sabljak, K. Ebrahimi, S. Dunjic, D. Velickovic, B. Spica. (2007) Iron deficiency anemia and its importance in gastroenterology clinical practice. Acta chirurgica iugoslavica 54:1, 91-105
CrossRef54
Mandeep S. Sawhney, Thokozeni Lipato, Douglas B. Nelson, Frank A. Lederle, Thomas S. Rector, John H. Bond. (2007) Should Patients With Anemia and Low Normal or Normal Serum Ferritin Undergo Colonoscopy?. The American Journal of Gastroenterology 102:1, 82-88
CrossRef55
Chaim Hershko, Mara Ianculovich, Moshe Souroujon. (2007) A hematologist's view of unexplained iron deficiency anemia in males: Impact of Helicobacter pylori eradication. Blood Cells, Molecules, and Diseases 38:1, 45-53
CrossRef56
Dong Il Park, Seung Ho Ryu, Suk Joong Oh, Tae Woo Yoo, Hong Ju Kim, Yong Kyun Cho, In Kyung Sung, Chong Il Sohn, Woo Kyu Jeon, Byung Ik Kim. (2006) Significance of Endoscopy in Asymptomatic Premenopausal Women with Iron Deficiency Anemia. Digestive Diseases and Sciences 51:12, 2372-2376
CrossRef57
Edmund J. Bini, Jean-Pierre Reinhold, Elizabeth H. Weinshel, Ramon Generoso, Loay Salman, Georges Dahr, Ivan Pena-Sing. (2006) Prospective Evaluation of the Use and Outcome of Admission Stool Guaiac Testing: The Digital Rectal Examination on Admission to the Medical Service (DREAMS) Study. Journal of Clinical Gastroenterology 40:9, 821-827
CrossRef58
Mehmet Aslan, Mehmet Horoz, Abdurrahim Kocyigit, Saadet Ozgonül, Hakim Celik, Metin Celik, Ozcan Erel. (2006) Lymphocyte DNA damage and oxidative stress in patients with iron deficiency anemia. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 601:1-2, 144-149
CrossRef59
Thomas Frieling. (2006) The clinical impact of capsule endoscopy: to believe or not to believe. European Journal of Gastroenterology & Hepatology 18:8, 873-874
CrossRef60
Richard Eisenstaedt, Brenda W.J.H. Penninx, Richard C. Woodman. (2006) Anemia in the elderly: Current understanding and emerging concepts. Blood Reviews 20:4, 213-226
CrossRef61
Sa A. Wang, Oluwole Fadare, Anil Nagar, Nelofar Q. Shafi, Michal G. Rose. (2006) Gastrointestinal endoscopic findings in men with unexplained anemia and low normal ferritin values. American Journal of Hematology 81:5, 324-327
CrossRef62
F. BACCINI, M. A. ALOE SPIRITI, L. VANNELLA, B. MONARCA, G. DELLE FAVE, B. ANNIBALE. (2006) Unawareness of gastrointestinal symptomatology in adult coeliac patients with unexplained iron-deficiency anaemia presentation. Alimentary Pharmacology and Therapeutics 23:7, 915-921
CrossRef63
Njaal Stray, Ragnar Weberg. (2006) A prospective study of same day bi-directional endoscopy in the evaluation of patients with occult gastrointestinal bleeding. Scandinavian Journal of Gastroenterology1-1
CrossRef64
Annie On On Chan, Kam Chuen Lai. (2006) A patient with long-standing iron-deficient anemia. Nature Clinical Practice Gastroenterology & Hepatology 3:2, 112-116
CrossRef65
Peter Jacobs, Lucille Wood, Peter Baker, Annare Ellmann, Martyn Payne. (2005) Silent angiodysplasia and occult haemobilia as rare but treatable causes of refractory iron deficiency—two case reports. Hematology 10:6, 457-460
CrossRef66
Don C. Rockey. (2005) Occult Gastrointestinal Bleeding. Gastroenterology Clinics of North America 34:4, 699-718
CrossRef67
Martin W. James, Chih-Mei Chen, William P. Goddard, Brian B. Scott, Andrew F. Goddard. (2005) Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. European Journal of Gastroenterology & Hepatology 17:11, 1197-1203
CrossRef68
R. Rivera-Irigoín, C. de Sola-Earle, F. Palma-Carazo, N. Montiel Quezel-Guerraz, N. Fernández-Moreno, E. Ubiña-Aznar, F. Fernández-Pérez. (2005) Hemorragia digestiva baja grave activa por úlcera apendicular. Gastroenterología y Hepatología 28:8, 445-446
CrossRef69
Richard Woodman, Luigi Ferrucci, Jack Guralnik. (2005) Anemia in older adults. Current Opinion in Internal Medicine 4:3, 261-266
CrossRef70
Andrew D. Hopper, John S. Leeds, David P. Hurlstone, Marios Hadjivassiliou, Kaye Drew, David S. Sanders. (2005) Are lower gastrointestinal investigations necessary in patients with coeliac disease?. European Journal of Gastroenterology & Hepatology 17:6, 617-621
CrossRef71
Bradford H. Jones, David E. Fleischer, Virender K. Sharma, Russell I. Heigh, Arthur D. Shiff, Jose L. Hernandez, Jonathan A. Leighton. (2005) Yield of Repeat Wireless Video Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding. The American Journal of Gastroenterology 100:5, 1058-1064
CrossRef72
NAM Q NGUYEN, CHRISTOPHER K RAYNER, MARK N SCHOEMAN. (2005) Push enteroscopy alters management in a majority of patients with obscure gastrointestinal bleeding. Journal of Gastroenterology and Hepatology 20:5, 716-721
CrossRef73
Suja DuBois, David J. Kearney. (2005) Iron-Deficiency Anemia and Helicobacter pylori Infection: A Review of the Evidence. The American Journal of Gastroenterology 100:2, 453-459
CrossRef74
Chao-Hung Ho, Wing-Keung Chau, Hui-Chi Hsu, Jyh-Pyng Gau, Jie-Yu You, Chih-Cheng Chen. (2005) Predictive risk factors and prevalence of malignancy in patients with iron deficiency anemia in Taiwan. American Journal of Hematology 78:2, 108-112
CrossRef75
Scott W Grisolano, Amy S Oxentenko, Joseph A Murray, Lawrence J Burgart, Ross A Dierkhising, Jeffrey A Alexander. (2004) The Usefulness of Routine Small Bowel Biopsies in Evaluation of Iron Deficiency Anemia. Journal of Clinical Gastroenterology 38:9, 756-760
CrossRef76
F. Panzuto, E. Di Giulio, G. Capurso, F. Baccini, G. D'Ambra, G. Delle Fave, B. Annibale. (2004) Large hiatal hernia in patients with iron deficiency anaemia: a prospective study on prevalence and treatment. Alimentary Pharmacology and Therapeutics 19:6, 663-670
CrossRef77
Zvi Fireman. (2004) The light from the beginning to the end of the tunnel. Gastroenterology 126:3, 914-916
CrossRef78
Bryan T. Green, Don C. Rockey. (2004) Gastrointestinal Endoscopic Evaluation of Premenopausal Women With Iron Deficiency Anemia. Journal of Clinical Gastroenterology 38:2, 104-109
CrossRef79
Gökhan Baysoy, Deniz Ertem, Evin Ademoğlu, Esin Kotiloğlu, Sabiha Keskin, Ender Pehlivanoğlu. (2004) Gastric Histopathology, Iron Status and Iron Deficiency Anemia in Children with Helicobacter pylori Infection. Journal of Pediatric Gastroenterology and Nutrition 38:2, 146-151
CrossRef80
Z Fireman, Y Kopelman. (2004) The role of video capsule endoscopy in the evaluation of iron deficiency anaemia. Digestive and Liver Disease 36:2, 97-102
CrossRef81
Don C. Rockey. 2004. Occult Gastrointestinal Bleeding. , 5-15.
CrossRef82
Umaprasanna S. Karnam, Lewis R. Felder, Jeffrey B. Raskin. (2004) Prevalence of Occult Celiac Disease in Patients with Iron-Deficiency Anemia: A Prospective Study. Southern Medical Journal 97:1, 30-34
CrossRef83
Zvi Fireman, Shosh Friedman. (2004) Diagnostic Yield of Capsule Endoscopy in Obscure Gastrointestinal Bleeding. Digestion 70:3, 201-206
CrossRef84
F. J. Baillie, A. E. Morrison, I. Fergus. (2003) Soluble transferrin receptor: a discriminating assay for iron deficiency. Clinical and Laboratory Haematology 25:6, 353-357
CrossRef85
B. Annibale, G. Capurso, F. Baccini, E. Lahner, G. D’Ambra, E. Di Giulio, G.Delle Fave. (2003) Role of small bowel investigation in iron deficiency anaemia after negative endoscopic/histologic evaluation of the upper and lower gastrointestinal tract. Digestive and Liver Disease 35:11, 784-787
CrossRef86
Kelley Scanlon, Lisa Bodnar, Mary Cogswell. 2003. Nutritional Anemias. , 213-242.
CrossRef87
Elizabeth Cyran. (2003) Update in Diagnosis and Treatment of Iron Deficiency. Primary Care Case Reviews 6:2, 83-89
CrossRef88
Trevor N. Brooklyn, Alexandra J. Di Mambro, Neil Haslam. (2003) Patients over 45 years with iron deficiency require investigation. European Journal of Gastroenterology & Hepatology 15:5, 535-538
CrossRef89
B. Lewis, N. Goldfarb. (2003) The advent of capsule endoscopy - a not-so-futuristic approach to obscure gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 17:9, 1085-1096
CrossRef90
B Annibale, G Capurso, G Delle Fave. (2003) The stomach and iron deficiency anaemia: a forgotten link. Digestive and Liver Disease 35:4, 288-295
CrossRef91
Mitchell S Cappell. (2003) Colon cancer during pregnancy. Gastroenterology Clinics of North America 32:1, 341-383
CrossRef92
Mitchell S Cappell, David Friedel. (2002) The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders. Medical Clinics of North America 86:6, 1165-1216
CrossRef93
Mitchell S Cappell, David Friedel. (2002) The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: technique, indications, and contraindications. Medical Clinics of North America 86:6, 1217-1252
CrossRef94
Zvi Lefkovitz, Mitchell S Cappell, Robert Lookstein, Harold A Mitty, Perry S Gerard. (2002) Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia. Medical Clinics of North America 86:6, 1357-1399
CrossRef95
Joseph F. Fitzgerald, Riccardo Troncone, Vincenzo Rutigliano, Domenica De Venuto, Domenico Brindicci, Fernando Prete, Vincenzo Tota. (2002) Clinical Quiz. Journal of Pediatric Gastroenterology and Nutrition 35:2, 205
CrossRef96
M.R. Thompson. (2002) ACPGBI Referral guidelines for colorectal cancer. Colorectal Disease 4:4, 287-297
CrossRef97
W. Dickey. (2002) Iron deficiency, gastric atrophy and Helicobacter pylori. Digestive and Liver Disease 34:5, 313-315
CrossRef98
Akheel A. Syed, Mohammed F. Silwadi, Bibi A. Khatoon. (2002) Detection and diagnosis of blood in feces and urine: an overview. Clinica Chimica Acta 318:1-2, 1-17
CrossRef99
Ahmad Hamwi, Georg Endler, Karl Rubi, Oswald Wagner, Arno Thomas Endler. (2002) Reference Values for a Heterogeneous Ferritin Assay and Traceability to the 3rd International Recombinant Standard for Ferritin (NIBSC Code 94/572). Clinical Chemistry and Laboratory Medicine 40:4, 365-370
CrossRef100
Edmund J. Bini, Jeffrey S. Unger, Elizabeth H. Weinshel. (2002) Outcomes of Endoscopy in Patients With Iron Deficiency Anemia After Billroth II Partial Gastrectomy. Journal of Clinical Gastroenterology 34:4, 421-426
CrossRef101
YAN M TAN, MOHAMED ROSMAWATI, PRABHAKERAN RANJEEV, KHEAN L GOH. (2002) Predictive factors by multivariate analysis for colorectal cancer in Malaysian patients undergoing colonoscopy. Journal of Gastroenterology and Hepatology 17:3, 281-284
CrossRef102
I DEZWART, G GRIFFIOEN, M SHAW, C LAMERS, A DEROOS. (2001) Barium Enema and Endoscopy for the Detection of Colorectal Neoplasia: Sensitivity, Specificity, Complications and its Determinants. Clinical Radiology 56:5, 401-409
CrossRef103
W van Mook. (2001) The outcome of esophagogastroduodenoscopy (EGD) in asymptomatic outpatients with iron deficiency anemia after a negative colonoscopy. European Journal of Internal Medicine 12:2, 122-126
CrossRef104
Irene E. M. Bultink, Willem F. Lems, Rob J. van de Stadt, Huibert J. Dinant, Anja Leyte, Diana S. Park, Margaret H. M. T. de Koning, Ben A. C. Dijkmans. (2001) Ferritin and serum transferrin receptor predict iron deficiency in anemic patients with rheumatoid arthritis. Arthritis & Rheumatism 44:4, 979-981
CrossRef105
Thomas E. Meister, Nicholas J. Nickl, Adrian Park. (2001) Laparoscopic-assisted panenteroscopy. Gastrointestinal Endoscopy 53:2, 236-239
CrossRef106
Akheel A Syed, Bibi A Khatoon, Mohammed F Silwadi. (2001) New reagents for detection of faecal occult blood. Journal of Pharmaceutical and Biomedical Analysis 24:4, 581-586
CrossRef107
Bruno Annibale, Gabriele Capurso, Gina Martino, Cristina Grossi, Gianfranco Delle Fave. (2000) Iron deficiency anaemia and Helicobacter pylori infection. International Journal of Antimicrobial Agents 16:4, 515-519
CrossRef108
D. J. Unsworth, R. J. Lock, R. F. Harvey. (2000) Improving the diagnosis of coeliac disease in anaemic women. British Journal of Haematology 111:3, 898-901
CrossRef109
A Bernard. (2000) Lower gastrointestinal vascular lesions: current concepts in diagnosis and treatment. Current Surgery 57:4, 313-317
CrossRef110
Mitchell S. Cappell, Muhammad Abdullah. (2000) MANAGEMENT OF GASTROINTESTINAL BLEEDING INDUCED BY GASTROINTESTINAL ENDOSCOPY. Gastroenterology Clinics of North America 29:1, 125-167
CrossRef111
Blair S. Lewis. (2000) SMALL INTESTINAL BLEEDING. Gastroenterology Clinics of North America 29:1, 67-95
CrossRef112
Gary R. Zuckerman, Chandra Prakash, Matthew P. Askin, Blair S. Lewis. (2000) AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 118:1, 201-221
CrossRef113
(2000) American Gastroenterological Association medical position statement: Evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 118:1, 197-200
CrossRef114
Francisco C. Ramirez. (1999) Small bowel bleeding. Current Treatment Options in Gastroenterology 2:5, 355-362
CrossRef115
Roger J. Charles, Amitabh Chak, Gregory S. Cooper, Richard C.K. Wong, Michael V. Sivak. (1999) Use of open access in GI endoscopy at an academic medical center. Gastrointestinal Endoscopy 50:4, 480-485
CrossRef116
Rockey, Don C., . (1999) Occult Gastrointestinal Bleeding. New England Journal of Medicine 341:1, 38-46
Full Text117
Andrew F Goddard, Alistair S McIntyre, Brain B Scott, William P Goddard, Richard G Long. (1999) Iron-deficiecy anaemia in premenopausal women. The Lancet 353:9157, 1014-1015
CrossRef118
M. Marignani, G. Delle Fave, S. Mecarocci, C. Bordi, S. Angeletti, G. D'Ambra, M.R. Aprile, V.D. Corleto, B. Monarca, B. Annibale. (1999) High prevalence of atrophic body gastritis in patients with unexplained microcytic and macrocytic anemia. A prospective screening study. The American Journal of Gastroenterology 94:3, 766-772
CrossRef119
DJ Unsworth, FJ Lock, RF Harvey. (1999) Iron-deficiency anaemia in premenopausal women. The Lancet 353:9158, 1100
CrossRef120
Major Thomas Kepczyk, Major James E. Cremins, Brian D. Long, Major Matthew B.Z. Bachinski, L. Ramona Smith, Colonel Peter R. McNally. (1999) A prospective, multidisciplinary evaluation of premenopausal women with iron-deficiency anemia. The American Journal of Gastroenterology 94:1, 109-115
CrossRef121
Richard J Farrell, J Thomas LaMont. (1998) Rational approach to iron-deficiency anaemia in premenopausal women. The Lancet 352:9145, 1953-1954
CrossRef122
ALYN L. ADRAIN, MARTA A. DABEZIES, BENJAMIN KREVSKY. (1998) Enteroscopy Improves the Clinical Outcome in Patients with Obscure Gastrointestinal Bleeding. Journal of Laparoendoscopic & Advanced Surgical Techniques 8:5, 279-284
CrossRef123
Pawson, Mehta. (1998) Review article: the diagnosis and treatment of haematinic deficiency in gastrointestinal disease. Alimentary Pharmacology and Therapeutics 12:8, 687-698
CrossRef124
John G. Lee, Geronimo Sahagun, Megan A. Oehlke, David A. Lieberman. (1998) Serious gastrointestinal pathology found in patients with serum ferritin values <= 50 ng/ml. The American Journal of Gastroenterology 93:5, 772-776
CrossRef125
Mitchell S. Cappell. (1998) COLON CANCER DURING PREGNANCY. Gastroenterology Clinics of North America 27:1, 225-256
CrossRef126
Zvi Fireman, Yael Kopelman, Amos Sternberg. (1998) Endoscopic Evaluation of Iron Deficiency Anemia and Follow-up in Patients Older Than Age 50. Journal of Clinical Gastroenterology 26:1, 7-10
CrossRef127
OMP Jolobe. (1997) Iron deficiency in benign duodenal ulcer. The Lancet 349:9054, 809-810
CrossRef128
P. A. Bampton, R. H. Holloway. (1996) A prospective study of the gastroenterological causes of iron deficiency anaemia in a General Hospital. Australian and New Zealand Journal of Medicine 26:6, 793-799
CrossRef129
Maj Thomas Kepczyk, Col Shailesh C. Kadakia. (1995) Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Digestive Diseases and Sciences 40:6, 1283-1289
CrossRef130
Lee Goldman. (1995) Internal medicine update. Journal of General Internal Medicine 10:6, 331-341
CrossRef131
Duffy, Thomas P.. (1994) An Anatomy Lesson. New England Journal of Medicine 331:5, 318-320
Full Text132
(1994) Evaluation of the Gastrointestinal Tract in Patients with Iron-Deficiency Anemia. New England Journal of Medicine 330:17, 1239-1240
Full Text133
(1994) Übersicht. LaboratoriumsMedizin 18:7-8, 305-310
CrossRef
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