How to confirm the causes of iron deficiency anemia in young women

Iron-deficiency anaemia (IDA) is commonly seen in women aged <50 years. The diagnostic workflow in young women affected by IDA is not clearly established. The British Society of Gastroenterology recommends gastroscopy only in IDA women younger than 45 years presenting with gastrointestinal (GI) symptoms. However, symptoms are often mild and aspecific in IDA women and the gastroscopy is an invasive procedure associated with a high number of refusals. In a previous work on IDA premenopausal women, gastroscopy was performed in all patients, later deemed unnecessary in almost 30% of the studied women because these were affected only by menorrhagia.

A research team led by Bruno Annibale from Italy prospectively evaluate the usefulness of a pre-endoscopic serological screening for H. pylori infection and celiac disease with the use of two tests (human recombinant tissue transglutaminase IgA antibodies and anti-H. pylori IgG antibodies) in women aged < 50 affected by IDA in order to increase the compliance for gastroscopy. Their study will be published on June 14, 2009 in the World Journal of Gastroenterology

In this study, 115 women aged < 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies (tTG) and anti-H. pylori IgG antibodies. All cases underwent gastroscopy with biopsies of stomach and duodenum, irrespective of tests results. Of the 115 patients, 45.2% of women were test-positive. The serological results were confirmed by gastroscopy in 100% of those with positive H. pylori antibodies, in 50% of those with positive tTG and in 81.5% of test-negative patients. Sensitivity and specificity were 84.8% and 100% for H. pylori infection, and 80% and 92.8% for tTG, respectively. The gastroscopy compliance rate of test-positive women was significantly increased in comparison with those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239).

This study showed that two simples and widely available tests, such as those for tissue transglutaminase IgA antibodies and anti-H. pylori IgG antibodies, were able to select women with IDA to submit for gastroscopy to identify IDA-related GI causes and to increase the compliance for the invasive procedure. Gastroscopy with biopsies confirmed in the vast majority of IDA women the presence of active H. pylori pangastritis, atrophic gastric body, or celiac disease as possible causes of IDA.

Reference: Vannella L, Gianni D, Lahner E, Amato A, Grossi E, Delle, Fave G, Annibale B. Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women. World J Gastroenterol 2009; 15(22): 2748-2753 http://www.wjgnet.com/1007-9327/15/2748.asp

Correspondence to: Bruno Annibale, MD, Department of Digestive and Liver Disease, Sant'Andrea Hospital, 1035 Grottorossa Street, 00189 Rome, Italy. bruno.annibale@uniroma1.it

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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