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Hodges S, Attree C, Picardo S, Faithfull T, McElholm A, Ragunath K. Prevalence of gastrointestinal malignancy in non-anemic iron deficiency and significance for endoscopic screening: A Western Australian multicenter cohort study. J Gastroenterol Hepatol 2023; 38:1530-1534. [PMID: 37198146 DOI: 10.1111/jgh.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND AND AIM There is a paucity of evidence regarding non-anemic iron deficiency as a predictor for colorectal cancer and therefore the indication for endoscopic evaluation. This study explores the rates of malignancy in adults with iron deficiency with and without anemia. METHODS A retrospective multicenter diagnostic cohort study was conducted across two Australian health services. All cases that underwent both esophagogastroduodenoscopy and colonoscopy between September 1, 2018, and December 31, 2019, for the investigation of iron deficiency were included, and the cohort was divided into anemic and non-anemic arms. Multivariate binomial logistic regression was performed to establish clinical characteristics associated with neoplasia. RESULTS Five hundred eighty-four patients underwent endoscopic evaluation over a 16-month period. There was a significantly higher rate of malignancy in the iron deficiency anemia arm as compared with those without anemia (8.76% vs 1.20%, P < 0.01). Gastrointestinal pathology to account for iron deficiency was identified in > 60% of the total cohort. The presence of anemia (odds ratio [OR] 6.87, P < 0.01) and male gender (OR 3.01, P = 0.01) were significant predictors of malignancy. CONCLUSION This study demonstrates that anemic iron deficiency confers a significantly greater risk of gastrointestinal cancer compared with non-anemic iron deficiency. Additionally, over 60% of patients had gastrointestinal pathology to account for iron deficiency overall, supporting the need to perform baseline endoscopy in patients with iron deficiency.
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Affiliation(s)
- Samantha Hodges
- Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia
| | - Chloe Attree
- Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia
| | - Sherman Picardo
- Royal Perth Bentley Group, Perth, Western Australia, Australia
- Curtin University, Perth, Western Australia, Australia
| | | | - Adrian McElholm
- Rockingham General Hospital, Perth, Western Australia, Australia
| | - Krish Ragunath
- Royal Perth Bentley Group, Perth, Western Australia, Australia
- Curtin University, Perth, Western Australia, Australia
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Tisserand J, Randrian V, Paccalin M, Saulnier PJ, Arviset M, Fourmy A, Arriudarré V, Jamet A, Moreno Y, Valéro S, Liuu E. Association between Iron Deficiency and Survival in Older Patients with Cancer. Cancers (Basel) 2023; 15:cancers15051533. [PMID: 36900329 PMCID: PMC10000607 DOI: 10.3390/cancers15051533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND iron deficiency (ID) is frequent in older patients. PURPOSE to evaluate the association between ID and survival in patients ≥ 75 years old with confirmed solid tumors. METHODS a retrospective monocentric study including patients between 2009 and 2018. ID, absolute ID (AID) and functional ID (FID) were defined according to the European Society for Medical Oncology (ESMO) criteria. Severe ID was defined by a ferritin level < 30 µg/L. RESULTS in total, 556 patients were included, the mean age was 82 (±4.6) years, 56% were male, the most frequent cancer was colon cancer (19%, n = 104), and metastatic cancers were found in 38% (n = 211). Median follow-up time: 484 [190-1377] days. In anemic patients, ID and FID were independently associated with an increased risk of mortality (respectively, HR 1.51; p = 0.0065 and HR 1.73; p = 0.0007). In non-anemic patients, FID was independently associated with better survival (HR 0.65; p = 0.0495). CONCLUSION in our study, ID was significantly associated with survival, and with better survival for patients without anemia. These results suggest that attention should be paid to the iron status in older patients with tumors and raise questions about the prognostic value of iron supplementation for iron-deficient patients without anemia.
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Affiliation(s)
- Julie Tisserand
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Violaine Randrian
- ProDiCeT, CHU Poitiers, Université de Poitiers, 86000 Poitiers, France
- Gastroenterology and Hepatology Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Marc Paccalin
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Pierre-Jean Saulnier
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Marine Arviset
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Arthur Fourmy
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Victor Arriudarré
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Amélie Jamet
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Yvan Moreno
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Simon Valéro
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Evelyne Liuu
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
- Correspondence:
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Alobidan A, Amin HS. Association between anemia and gastrointestinal malignancy among male patients in a university hospital in Riyadh, Saudi Arabia. J Family Med Prim Care 2021; 10:2781-2787. [PMID: 34660405 PMCID: PMC8483140 DOI: 10.4103/jfmpc.jfmpc_2456_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/28/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Iron deficiency was reported as the most common nutritional deficiency in developing and developed countries. Many studies reported that iron deficiency anemia (IDA) is related to the development of gastrointestinal (GI) malignancies Aim: The current study aimed at investigating the prevalence of iron deficiency anemia among Saudi patients subjected to endoscopy procedure, and to assess the association between iron deficiency anemia and GI malignancy. Method: A retrospective study was performed over 244 Saudi patients attending King Saud University Hospital (KSUH) in Riyadh, Saudi Arabia between 2015 and 2018. Data were collected from the hospital database (esihi). Patients aged 30 years or more were recruited in this study. They had to be subjected to endoscopy before the recruitment period. Complete blood count analysis was performed for the blood samples collected from the patients. Results: The findings of the study showed that the prevalence of IDA among Saudi patients was 63.5%. Gastritis (15.16%), colon carcinoma (13.11%), and polyps (12.7%) were the most reported endoscopy results among patients with IDA. In addition, it was found that there is no significant association between IDA and GI malignancy. Conclusion: The study concluded that despite the reported significant association between IDA and GI malignancy, the current study revealed that there is no significant association between IDA and GI malignancy. This might be attributed to sample-related issues, which require more extended studies investigating larger sample sizes, in addition to including ferritin level measurements for the investigated patients.
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Affiliation(s)
- Abdulmhsen Alobidan
- Department of Family and Community Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein S Amin
- Department of Family and Community Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
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Clackett W, Barclay ST, Stanley AJ, Cahill A. The Value of Quantitative Faecal Immunochemical Testing as a Prioritisation Tool for the Endoscopic Investigation of Patients With Iron Deficiency. Front Med (Lausanne) 2021; 8:700753. [PMID: 34368194 PMCID: PMC8339881 DOI: 10.3389/fmed.2021.700753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Difficulty in providing endoscopy for patients with iron deficiency anaemia (IDA) during the COVID-19 pandemic has highlighted the requirement for a prioritisation tool. We aimed to test the validity of qFIT as a prioritisation tool in patients with iron deficiency and its ability to identify patients with advanced neoplastic lesions (ANLs). Data collected from patients referred with biochemically proven iron deficiency (ferritin ≤ 15 μg/L) and synchronous qFIT who underwent full gastrointestinal investigation within NHS Greater Glasgow and Clyde was analysed retrospectively. Patients who did not undergo full investigation, defined as gastroscopy and colonoscopy or CT colonography, were excluded. ANLs were defined as defined as upper GI cancer, colorectal adenoma ≥ 1 cm or colorectal cancer. Area under the curve (AUC) analysis was performed on qFIT results and outcome, defined as the presence of an ANL. AUC analysis guided cut-off scores for qFIT. Patients with a qFIT of <10, 10–200, >200, were allocated a score of 1, 2, and 3, respectively. A total of 575 patients met criteria for inclusion into the study. Overall, qFIT results strongly predicted the presence of ANLs (AUC 0.87, CI 0.81–0.92; P < 0.001). The prevalence of ANLs in patients with scores 1–3 was 1.2, 13.5, and 38.9% respectfully. When controlled for other significant variables, patients with a higher qFIT score were statistically more likely to have an ANL (qFIT score = 2; OR 12.8; P < 0.001, qFIT score = 3, OR 50.0; P < 0.001). A negative qFIT had a high NPV for the presence of ANLs (98.8%, CI 97.0–99.5%). These results strongly suggest that qFIT has validity as a prioritisation tool in patients with iron deficiency; both allowing for a more informed decision of investigation of patients with very low risk of malignancy, and in identifying higher risk patients who may benefit from more urgent endoscopy.
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Affiliation(s)
- William Clackett
- Department of Gastroenterology, Glasgow Royal Infirmary, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Stephen T Barclay
- Department of Gastroenterology, Glasgow Royal Infirmary, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Adrian J Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Aidan Cahill
- Department of Gastroenterology, Glasgow Royal Infirmary, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
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Jolobe OMP. The index of suspicion for iron deficiency in non-anaemic subjects. Clin Med (Lond) 2021; 21:e428-e429. [DOI: 10.7861/clinmed.let.21.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Iron deficiency: a modern primer to diagnosis and management. Curr Opin Gastroenterol 2021; 37:121-127. [PMID: 33315792 DOI: 10.1097/mog.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Iron deficiency with anemia (IDA) and without anemia remain a diagnostic and management challenge. Iron deficiency has a broad spectrum of causes, including gastrointestinal malignancy. The purpose of this review is to summarize the value and limitations of current methods to diagnose iron deficiency and underline the relevance of contemporaneous evidence to guide the pretest probability of gastrointestinal disease. RECENT FINDINGS A number of biomarkers for iron deficiency exist, and all have their caveats. Serum ferritin remains the most pragmatic means of diagnosing iron deficiency. Hepcidin holds future promise as a marker of iron status during inflammatory states. Men and postmenopausal women with IDA have the highest overall prevalence of gastrointestinal malignancy (∼11%), while premenopausal women with IDA (<1.5%) and those with iron deficiency without anemia (<0.5%) have a very low risk. Noninvasive investigation with fecal immunochemical test and fecal calprotectin hold promise to guide further investigations in lower risk groups. SUMMARY Confirmation of iron deficiency remains a challenge. Appropriate risk stratification is the key to guiding judicious gastrointestinal investigation. Use of noninvasive tests may play an important role in lower risk groups. Risk prediction tools applicable to relevant populations are required.
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