Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia (IDA) in adult men and postmenopausal women. Gastroduodenal endoscopy (GDE) and colonoscopy are frequently recommended, despite uncertainty regarding the coexistence of lesions in the upper and lower GI tract. The faecal immunochemical test (FIT) measures the concentration of faecal haemoglobin (f-Hb) originating only from the colon or rectum. We aimed to assess whether the FIT was able to select the best endoscopic procedure for detecting the cause of IDA.
A prospective study of 120 men and postmenopausal women referred for a diagnostic study of IDA were evaluated with an FIT, GDE and colonoscopy. The endoscopic finding of a significant upper lesion (SUL) or a significant bowel lesion (SBL) was considered to be the cause of the IDA.
The diagnoses were 35.0% SUL and 20.0% SBL, including 13.3% GI cancer. In the multivariate analysis, the concentration of blood haemoglobin (b-Hb) <9 g/dL (OR: 2.60; 95% CI 1.13–6.00; p = 0.025) and non-steroidal anti-inflammatory drugs NSAIDs (2.56; 1.13–5.88; p = 0.024) were associated with an SUL. Age (0.93; 0.88–0.99; p = 0.042) and f-Hb ≥ 15 μg Hb/g faeces (38.53; 8.60–172.50; p < 0.001) were associated with an SBL. A “FIT plus gastroscopy” strategy, in which colonoscopy is performed only when f-Hb ≥15 μg Hb/g faeces, would be able to detect 92.4% of lesions and be 100% accurate in the detection of cancer while avoiding 71.6% of colonoscopies.
The FIT is an accurate method for selecting the best endoscopy study for the evaluation of IDA. An FIT-based strategy is more cost-effective than the current bidirectional endoscopy-based strategy and could improve endoscopic resource allocation.
We would like to thank Esther Quilez for her administrative support, Natividad Valera for her technical support and David Bridgewater for his helpful advice and manuscript corrections.
Author contributions: LRA: study design, enrolment of patients, acquisition of data, analysis and interpretation of data, statistical analysis, drafting and revision of the manuscript; FRM: study design, enrolment of patients, analysis and interpretation of data, statistical analysis, drafting and revision of the manuscript; ARC: acquisition of data and revision of the manuscript; CA: acquisition of data and revision of the manuscript; KS: acquisition of data and revision of the manuscript; PG: acquisition of data and revision of the manuscript; GI: revision of the manuscript; BC: acquisition of data and revision of the manuscript; JG: study design, analysis and interpretation of data, statistical analysis, drafting and revision of the manuscript, and corresponding author. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This work was supported by a grant from the Societat Catalana de Digestolologia (SCD), Catalonia, Spain and by the Instituto de Salud Carlos III, co-founded by FEDER funds – a way to build Europa – (grants PI11/01439 and PI11/01593). The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2019-0203).
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