Gastrointestinal Evaluation of Iron Deficiency Anemia
Publication Date: August 15, 2020
Last Updated: March 14, 2022
Recommendation Statements
In patients with anemia, the AGA recommends using a cutoff of 45 ng/mL over 15 ng/mL when using ferritin to diagnose iron deficiency. (High, Strong)
Comment: In patients with inflammatory conditions or chronic kidney disease, other laboratory tests such as C-reactive protein, transferrin saturation, or soluble transferrin saturation, may be needed in conjunction with ferritin to diagnose iron deficiency anemia.
612
In asymptomatic postmenopausal women and men with iron deficiency anemia, the AGA recommends bidirectional endoscopy over no endoscopy. (Moderate, Strong)
612
In asymptomatic premenopausal women with iron deficiency anemia, the AGA suggests bidirectional endoscopy over iron replacement therapy only. (Moderate, Conditional (weak))
Comment: Patients who place a high value on avoiding the small risk of endoscopy, particularly those who are young and might have other plausible reasons for IDA, and a low value on the very small risk of missing a gastrointestinal malignancy would reasonably select an initial course of iron replacement therapy and no initial bidirectional endoscopy.
612
In patients with iron deficiency anemia without other identifiable etiology after bidirectional endoscopy, the AGA suggests noninvasive testing for Helicobacter pylori, followed by treatment if positive, over no testing. (Low, Conditional (weak))
612
In patients with iron-deficiency anemia, the AGA suggests against the use of routine gastric biopsies to diagnose atrophic gastritis. (Very Low, Conditional (weak))
612
In asymptomatic adult patients with iron deficiency anemia and plausible celiac disease, the AGA suggests initial serologic testing, followed by small bowel biopsy only if positive, over routine small bowel biopsies. (Very Low, Conditional (weak))
Comment: Celiac disease is a well-recognized cause of iron deficiency anemia, even in asymptomatic patients, and, therefore it must be considered in the differential diagnosis of iron deficiency anemia.
612
In uncomplicated asymptomatic patients with iron deficiency anemia and negative bidirectional endoscopy, the AGA suggests a trial of initial iron supplementation over the routine use of video capsule endoscopy. (Very Low, Conditional (weak))
Comment: Caution needs to be applied in patients with comorbid conditions where the identification of small bowel pathology will change medical management, such as the use of anticoagulation and/or antiplatelet therapy.
612
Recommendation Grading
Overview
Title
Gastrointestinal Evaluation of Iron Deficiency Anemia
Authoring Organization
American Gastroenterological Association
Publication Month/Year
August 15, 2020
Last Updated Month/Year
February 6, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital, Laboratory services, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening
Diseases/Conditions (MeSH)
D007501 - Iron, D018798 - Anemia, Iron-Deficiency
Keywords
environmental control, IDA