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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.


Contact: Lai-Fu Li
World Journal of Gastroenterology

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