Diagnostic Yield of Malignancy and Coeliac Disease in Biopsies at Upper Gastrointestinal Endoscopy in Patients with Iron Deficiency Anaemia (IDA)
Publication date: November 2019Source: European Journal of Surgical Oncology, Volume 45, Issue 11Author(s): Stephen Stonelake, Jessica Wilkinson, Sevim Gulmez, Edmund Leung
The objective of this study was to describe the current state of CD diagnosis and treatment patterns. A targeted review of literature from MEDLINE, Embase, the Cochrane Library, and screening of relevant conference abstracts was performed. The generally recommended diagnostic approach is GI endoscopy with small bowel biopsy; however, in selected patients, biopsy may be avoided and diagnosis based on positive serology and clinical symptoms. Diagnosis often is delayed; the average diagnostic delay after symptom onset is highly variable and can last up to 12 years. Barriers to accurate and timely diagnosis include atypi...
Conclusions: A duodenal biopsy is more likely to be performed in younger patients, females, and for key indications such as weight loss, diarrhea, and anemia. Providers varied widely in the performance of duodenal biopsy. Further study is warranted to better understand the decision to perform duodenal biopsy and to determine the optimal scenarios for its performance.
We present the case of a 1-year-old male child, with a history of idiopathic pericardial effusion, admitted in our clinic for severe abdominal bloating, irritability, loss of appetite and intermittent diarrheic stools. The clinical findings were: influenced general status, irritability, distended abdomen, and diffuse abdominal tenderness. Diagnoses: The initial laboratory tests revealed anemia, leukocytosis, increased inflammatory biomarkers, high levels of transaminases, and hypoalbuminemia. The stool culture identified an enterocolitis with enteropathogenic Escherichia coli (E. coli). Interventions: We initiated an...
Many patients who present with undiagnosed iron deficiency anemia (IDA) are presumed to have occult gastrointestinal (GI) bleeding as the cause. When investigations include a negative upper endoscopy and colonoscopy, a negative celiac antibody screen and there is no obvious GI source of blood loss, occult GI bleeding from a small bowel source is considered and capsule endoscopy (CE) is pursued. Recent guidelines on the use of CE published in Gasroenterology suggested that CE is indicated in only selected cases of iron deficiency anemia; however, evidence on the yield of CE in IDA and how to optimally select cases is limited.
ConclusionsRandom duodenal biopsy is not a cost-effective method of diagnosing coeliac disease and should be replaced with pre-endoscopy coeliac serology.
CONCLUSION: In the Northern Indian tertiary-care hospital outpatient setting, Celiac disease was associated with 4% of children presenting with moderate-to-severe anemia. PMID: 29396932 [PubMed - in process]
A 58-year-old male who was vegetarian by diet, with no previous comorbidities, presented with easy fatigability, dyspnoea on exertion and palpitations of 5-months duration. On examination, he had conjunctival pallor and spooning of multiple nails (Figure 1A). Rest of systemic examination was within normal limits. Investigations revealed haemoglobin of 95 g/l, mean corpuscular volume of 64.2 fl and peripheral blood film showed microcytic hypochromic anaemia with pencil cells and teardrop cells. Iron profile showed serum iron of 23 mcg/dl (normal 50–150 mcg/dl), total iron binding capacity ...
ConclusionsSerum tTGA levels can be used to predict villous atrophy and biopsy may be avoided in strongly suspected cases with more than 9 times of cut-offs.
CONCLUSION: GI complaints in Iranian children are a common feature. Screening of children with suspected CD, especially with GI symptom is highly recommended. PMID: 27845544 [PubMed - in process]
Conclusion In light of the high incidence of GI malignancies in this patient group, a low threshold for GI screening as well as mass screening for IDA is needed.