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Demir Eksikliği Anemisi Nedeniyle Endoskopi ve Kolonoskopi Yapılan Hastalarda Malignite Sıklığının Değerlendirilmesi

Yıl 2021, Cilt: 12 Sayı: 42, 29 - 33, 15.04.2021
https://doi.org/10.17944/mkutfd.855742

Öz

Giriş ve Amaç
Anemilerin çoğu gibi demir eksikliği anemisi de kendi başına bir hastalık değildir ve etyolojinin her hastada araştırılıp ortaya konması gerekmektedir. Demir eksikliği anemisi yaş gruplarına göre etyolojik nedenlerin sıklığı değişmektedir. Demir eksikliği anemisinin en önemli sebebi premenapozal kadınlarda menstrüel kanamalar iken; postmenapozal kadınlar ve erişkin erkeklerde ise gastrointestinal sistemden olan kronik kan kayıpları oluşturmaktadır. Bu çalışmada demir eksikliği nedeniyle endoskopi ve kolonoskopi yaptığımız hastaların malignite sıklığını değerlendirmeyi amaçladık.

Materyal ve Metod
2018 Aralık ve 2019 Temmuz ayları arasında demir eksikliği anemisi etyoloji taraması nedeniyle kolonoskopi ve endoskopi yaptığımız hastalarımızı çalışmaya aldık. Kolonoskopi uygun hazırlık sonrası terminal ileum da değerlendirilecek şekilde uygulanmıştı. Hastaların yaş, cinsiyet, anamnez bilgileri ve işlem sonuçlarına dosyaları araştırılarak geriye dönük olarak incelendi.

Bulgular
Bu sürede demir eksikliği anemisi nedeniyle 142 hastada kolonoskopi yapılmıştı. Bunların 130’una endoskopi de yapılmıştı. Hastaların %52,81’i erkek ve %47,18‘i kadındı. Erkeklerin yaş ortalaması 61,4±11,8, kadınların yaş ortalaması 55,2 ± 13,6 idi. Bunlardan %15,5 hastada kolonda polip saptandı ve bunların % 80,5'i adenomatöz polipti. % 7 hastada kolonda karsinom saptandı. Bu hastaların toplam %57,7’ünde de mide adenokanseri, ülser, gastrit, özofajit, özofagus varisi, polip ve özofafit gibi anemiyi açıklayabilecek patoloji saptandı. Toplam %64,8 hastada anemiyi açıklayabilecek ya endoskopik bulgu ya da kolonoskopik bulgu mevcuttu.

Tartışma ve Sonuç
Demir eksikliği anermisi labaratuar çalışmaları ile doğrulandıktan ve diyete bağlı demir eksikliği, demir ihtiyacında artış ve gastrointestinal sistem dışı kan kaybına bağlı anemi dışlandıktan sonra, gastrointestinal traktüsün endoskopik incelemesine geçilmelidir. Bu çalışmada olguların %15,5’inde kolonda polip , %7,04 hastada da adenokarsinom tespit ettik. Midede de %0,7 adenokarsinom tespit edildi. Bu da demir eksikliği anemisi etiyolojisinde hem endoskopi hem de kolonoskopinin önemini göstermektedir.

Kaynakça

  • World Health Organization. Nutritional Anemias: Report of a WHO Scientific Group. WHO Technical Reports Series 405. Geneva, Switzerland: World Health Organization, 1968.
  • Provan D. Mechanism and management of iron deficiency anemia. Br J Haematol 1999;105(Suppl 1):19-26.
  • Goddard AF, James MW, Mc Intyr AS, Scott BB. Guidelines for the management of iron deficiency anemia. Gut. 2011;60(10):1309-16. https://doi.org/10.1136/gut.2010.228874
  • Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal bleeding. Am Fam Physician 2013;87:430-6.
  • Çetinkaya ZA, Sezikli M, Güzelbulut F, ve ark. Demir eksikliği anemili hastalarda gastrointestinal endoskopik inceleme sonuçları. Dicle Tıp Dergisi 2011; 38:155-59. https://doi.org/10.5798/diclemedj.0921.2011.2.0006
  • James MW, Chen C-M, Goddard WP, et al. Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. Eur J Gastroenterol Hepatol 2005;17:1197-203. https://doi.org/10.1097/00042737-200511000-00008
  • McIntyre AS, Long RG. Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut 1993;34:1102- 7. https://doi.org/10.1136/gut.34.8.1102
  • Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 1993;329:1691- 5. https://doi.org/10.1056/NEJM199312023292303
  • Kepczyk T, Kadakia SC. Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Dig Dis Sci 1995;40:1283-99. Ho CH, Chau WK, Hsu HC, et al. Predictive risk factors and prevalence of malignancy in patients with iron deficiency anemia in Taiwan. Am J Hematol 2005;78:108-12. https://doi.org/10.1002/ajh.20260
  • Ioannou GN, Rockey DC, Bryson CL, et al. Iron deficiency and gastrointestinal malignancy: a population-based cohort study. Am J Med 2002;113:276-80. https://doi.org/10.1016/S0002-9343(02)01214-7
  • Majid S, Salih M, Wasaya R, Jafri M. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 2008;8:52. https://doi.org/10.1186/1471-230X-8-52
  • Ünal ÜH, Fidan C, Korkmaz M, Selçuk H. Demir eksikliği olan hastalarda gastrointestinal sistem endoskopi bulguları. Akademik Gastroenteroloji Dergisi 2012; 3:113-16.
  • Moses PL, Smith RE: Endoscopic evaluation of iron deficciency anemia. A guide to diagnostic strategy in older patients. Postgroduote medicine, 1995 98(2): 213-216, 219, 222-4. https://doi.org/10.1080/00325481.1995.11946039
  • Cook I J, Pavli P, Riley JW, Goulston KJ, Dent OF: Gastrointestinal investigation of iron deficiency anemia. British Medical Journal 1986 Vol 292: 1380-1382. https://doi.org/10.1136/bmj.292.6532.1380
  • Gordon SR, Smith RE, Power GC: The role of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol 1994; 89 (ll): 1963-1967.
  • Zuckerman G, Benitez J: A prospective study of bidirectional endoscopy (Colonoscopy and EGD) in the evaluation of patients with occult gastrointestinal bleeding. AM J Gastrointestinal 1992; 87: 62-66.
  • My Intyre AS, Long RG: Prospective survey of investigations in outpatient with iron deficiency anemia. Gut 1993; 34: 1102-1107. https://doi.org/10.1136/gut.34.8.1102

Evaluation of Frequency of Malignancy in Patients Undergoing Colonoscopy Due to Iron Deficiency Anemia

Yıl 2021, Cilt: 12 Sayı: 42, 29 - 33, 15.04.2021
https://doi.org/10.17944/mkutfd.855742

Öz

Introduction and purpose
Like most anemias, iron deficiency anemia is not a disease in itself and its etiology needs to be investigated and revealed in each patient. The frequency of etiological causes of iron deficiency anemia varies according to age groups. While the most important cause of iron deficiency anemia is menstrual bleeding in premenopausal women; It causes chronic blood loss from the gastrointestinal system in postmenopausal women and adult men. In this study, we aimed to evaluate the malignancy frequency in patients who underwent endoscopy and colonoscopy due to iron deficiency.

Material and Method
We included our patients who underwent colonoscopy and endoscopy for iron deficiency anemia etiology screening between December 2018 and July 2019. Colonoscopy was performed after appropriate preparation to be evaluated in the terminal ileum. Patients' age, gender, anamnesis information and procedure results were examined retrospectively by investigating their files.

Results
During this period, colonoscopy was performed in 142 patients due to iron deficiency anemia. 130 of them had also undergone endoscopy. 52.81% of the patients were men and 47.18% were women. The mean age of men was 61.4 ± 11.8, and the mean age of women was 55.2 ± 13.6. Of these, 15.5% of patients had polyps in the colon, and 80.5% of them were adenomatous polyp. Carcinoma in the colon was detected in 7% of the patients. In a total of 57.7% of these patients, pathology that could explain anemia such as gastric adenocarcinoma, ulcer, gastritis, esophagitis, esophageal varicose, polyps and esophagitis was detected. A total of 64.8% patients had either endoscopic findings or colonoscopic findings that could explain anemia.

Discussion and Conclusion
Endoscopic examination of the gastrointestinal tract should be started after iron deficiency anermia is confirmed by laboratory studies and after excluding anemia due to dietary iron deficiency, increased iron requirement and extra-gastrointestinal blood loss. In this study, we detected polyps in the colon in 15.5% of the cases, and adenocarcinoma in 7.04% of the patients. 0.7% adenocarcinoma was detected in the stomach. This shows the importance of both endoscopy and colonoscopy in the etiology of iron deficiency anemia.

Kaynakça

  • World Health Organization. Nutritional Anemias: Report of a WHO Scientific Group. WHO Technical Reports Series 405. Geneva, Switzerland: World Health Organization, 1968.
  • Provan D. Mechanism and management of iron deficiency anemia. Br J Haematol 1999;105(Suppl 1):19-26.
  • Goddard AF, James MW, Mc Intyr AS, Scott BB. Guidelines for the management of iron deficiency anemia. Gut. 2011;60(10):1309-16. https://doi.org/10.1136/gut.2010.228874
  • Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal bleeding. Am Fam Physician 2013;87:430-6.
  • Çetinkaya ZA, Sezikli M, Güzelbulut F, ve ark. Demir eksikliği anemili hastalarda gastrointestinal endoskopik inceleme sonuçları. Dicle Tıp Dergisi 2011; 38:155-59. https://doi.org/10.5798/diclemedj.0921.2011.2.0006
  • James MW, Chen C-M, Goddard WP, et al. Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. Eur J Gastroenterol Hepatol 2005;17:1197-203. https://doi.org/10.1097/00042737-200511000-00008
  • McIntyre AS, Long RG. Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut 1993;34:1102- 7. https://doi.org/10.1136/gut.34.8.1102
  • Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 1993;329:1691- 5. https://doi.org/10.1056/NEJM199312023292303
  • Kepczyk T, Kadakia SC. Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Dig Dis Sci 1995;40:1283-99. Ho CH, Chau WK, Hsu HC, et al. Predictive risk factors and prevalence of malignancy in patients with iron deficiency anemia in Taiwan. Am J Hematol 2005;78:108-12. https://doi.org/10.1002/ajh.20260
  • Ioannou GN, Rockey DC, Bryson CL, et al. Iron deficiency and gastrointestinal malignancy: a population-based cohort study. Am J Med 2002;113:276-80. https://doi.org/10.1016/S0002-9343(02)01214-7
  • Majid S, Salih M, Wasaya R, Jafri M. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 2008;8:52. https://doi.org/10.1186/1471-230X-8-52
  • Ünal ÜH, Fidan C, Korkmaz M, Selçuk H. Demir eksikliği olan hastalarda gastrointestinal sistem endoskopi bulguları. Akademik Gastroenteroloji Dergisi 2012; 3:113-16.
  • Moses PL, Smith RE: Endoscopic evaluation of iron deficciency anemia. A guide to diagnostic strategy in older patients. Postgroduote medicine, 1995 98(2): 213-216, 219, 222-4. https://doi.org/10.1080/00325481.1995.11946039
  • Cook I J, Pavli P, Riley JW, Goulston KJ, Dent OF: Gastrointestinal investigation of iron deficiency anemia. British Medical Journal 1986 Vol 292: 1380-1382. https://doi.org/10.1136/bmj.292.6532.1380
  • Gordon SR, Smith RE, Power GC: The role of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol 1994; 89 (ll): 1963-1967.
  • Zuckerman G, Benitez J: A prospective study of bidirectional endoscopy (Colonoscopy and EGD) in the evaluation of patients with occult gastrointestinal bleeding. AM J Gastrointestinal 1992; 87: 62-66.
  • My Intyre AS, Long RG: Prospective survey of investigations in outpatient with iron deficiency anemia. Gut 1993; 34: 1102-1107. https://doi.org/10.1136/gut.34.8.1102
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Original Articles
Yazarlar

Mustafa Zanyar Akkuzu 0000-0002-9908-6881

Orhan Sezgin 0000-0002-6704-4716

Serkan Yaraş 0000-0003-1404-7515

Osman Özdoğan 0000-0002-8299-5341

Hatice Rızaoğlu Balcı 0000-0002-5366-4535

Ferzan Aydın 0000-0003-0464-2003

Enver Üçbilek 0000-0002-2935-5580

Engin Altintas 0000-0003-0796-1456

Fehmi Ates 0000-0003-2527-414X

Yayımlanma Tarihi 15 Nisan 2021
Gönderilme Tarihi 7 Ocak 2021
Kabul Tarihi 5 Nisan 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 12 Sayı: 42

Kaynak Göster

Vancouver Akkuzu MZ, Sezgin O, Yaraş S, Özdoğan O, Rızaoğlu Balcı H, Aydın F, Üçbilek E, Altintas E, Ates F. Demir Eksikliği Anemisi Nedeniyle Endoskopi ve Kolonoskopi Yapılan Hastalarda Malignite Sıklığının Değerlendirilmesi. mkutfd. 2021;12(42):29-33.