Diagnostic Yield of Bidirectional Endoscopy for Iron Deficiency Anemia in Young Patients

Introduction: Iron deficiency is the most common cause of anemia worldwide. While bidirectional endoscopy is recognized as the standard approach for investigating IDA in men ≥ 45 years and postmenopausal women, evidence supporting the application of this approach in younger men and premenopausal women is scarce in the absence of symptoms. Our primary aim is to identify the diagnostic yield of bidirectional endoscopy in men ≤ 45 years and premenopausal women and describe the clinical characteristics of those with significant endoscopic and pathology-proven findings. Methods: We performed a retrospective chart review including patients ≤ 45 with IDA who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy at the Brooklyn VA Hospital from 2009 to 2023. Demographic, clinical, and endoscopic patient data was all collected, stratified, analyzed, and interpreted. Results: In 143 patients < 45 years with IDA (70.6% females, mean age 36.18 years, SD = 5.63), 28.6% were found to have positive upper GI findings, of which 70.3% were pathology-proven H. pylori cases. 57.9% of patients reported upper GI symptoms, while 42.9% of patients were asymptomatic. In total, 18.2% of symptomatic patients were found to have clinically significant findings on EGD as compared with 42.9% of asymptomatic patients. Additionally, 9.1% of symptomatic patients were found to have biopsy proven H. pylori-associated gastritis or duodenitis as compared with 33.9% of asymptomatic patients. Of the patients who underwent colonoscopy, 8.3% were found to have lower GI lesions. Conclusions: We found the diagnostic yield of EGD to be significantly higher than that of colonoscopy in younger IDA patients. Our findings suggest current guidelines are clinically relevant to the young patient cohort. Our study also interestingly found asymptomatic IDA patients below age 45 to have a significantly higher diagnostic yield of EGD as compared to symptomatic IDA patients within the same age cohort. We speculate that the differences in diagnostic yields may be a result of symptomatic patients being more likely to have been prescribed proton pump inhibitors or histamine receptor antagonists prior to endoscopy.