A 55-year-old postmenopausal woman consults for asthenia and dyspnea on exertion. In the anamnesis she reported slight epigastralgia and occasional heartburn. No metrorrhagia. Laboratory tests: Hb6 gr/dL, MCV 69 fl, sideremia 13 micrograms/dL, ferritin 4 ngr/mL. Gastrointestinal endoscopy: small sliding hiatal hernia with no signs of esophagitis. What is the most correct approach?
We have a case of chronic iron deficiency anemia, without obvious bleeding. The first cause of iron deficiency anemia is occult bleeding of digestive origin. The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy, but there is no pathology to justify the anemia, so further investigation is necessary, which rules out answers 1 and 2. Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions. In fact the recommendations of capsule endoscopy in anemia studies are restricted.
Administer oral iron and monitor the evolution of anemia.
Treat with proton pump inhibitors and evaluate at three months.
Recommend a complete colonoscopy.
Perform an endoscopic capsule study.
Request a gynecological evaluation.
The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy, but there is no pathology to justify the anemia, so further investigation is necessary, which rules out answers 1 and 2.
The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy, but there is no pathology to justify the anemia, so further investigation is necessary, which rules out answers 1 and 2.
Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions.
Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions.