Iron Deficiency Anemia: The Utility of Upper Gastrointestinal Endoscopy and Histopathology

Abstract

Background: occult blood loss must be considered as a
possible cause in every case of iron deficiency anemia.
Objective: to evaluate upper gastrointestinal endoscopy
in finding a potential cause for iron deficiency anemia
among children in Al-Anbar governorate.
Methods: Twenty five children aged 2-14 years, referred
to the gastroenterology unit in Al-Ramadi General Hospital
for upper gastrointestinal endoscopy had iron deficiency
anemia. Fiberoptic endoscopy was used under general
anesthesia and endoscopic tissue biopsies were taken from
22 patients for histopathological examination.
Results: The main presenting signs and symptoms were
pallor, abdominal pain, and stunting. The upper
gastrointestinal endoscopy showed thinning of duodenal
folds & serrated mucosa in 8 (32%), duodenal ulcer in 3
(12%), esophageal varices in 1 (4%), nodular gastritis in 1
(4%), and reflux esophagitis in1 (4%), with a yield rate of
56%.
While tissue biopsies revealed histopathological findings
suggestive of celiac disease in 12 (48%), Giardia lamblia in
2 (8%), Helicobacter pylori gastritis in 1 (4%), and
esophagitis in 1 (4%). There was a significant association
between the endoscopic finding of thinning of duodenal
folds and serrated mucosa and the histopathological
finding suggestive of celiac disease, P<0.05.
Conclusion: Iron deficiency anemia in children 2-14
years of age warrants upper gastrointestinal endoscopy to
find potentially treatable causes for the iron deficiency
anemia