ABSTRACT
Background and study aims: gastric cancer is highly prevalent in Kashmir, as are lower gastrointestinal [LGI] malignancies. Colonic cancer, gastric cancer, and coeliac disease are the most important gastrointestinal [GI] causes of iron deficiency anaemia [IDA] worldwide. Approximately 9% of patients with IDA present with a suspicious lesion in the GI tract upon examination. However, the absence of GI symptoms and a possible lesion accounting for blood loss in IDA have not been studied in this zone with a high prevalence of GI malignancy. We aimed to examine IDA patients without GI symptoms to determine the most plausible cause of their blood loss
Patients and methods: a total of 100 patients with IDA and 250 control subjects without IDA and referred for gastrointestinal endoscopy were enrolled in a cross-sectional, comparative study. Patients presenting with a significant lesion proportionate to their anaemia in the upper GI tract were not examined further, if no further strong indications were present
Results: twenty-nine patients [29%] were found to have malignancy: 13 with gastric cancer and 16 with colonic malignancies. Other apparent causes of GI blood loss included peptic ulcer disease in 10 [10%] patients, haemorrhoids in 22 [25%], polyps in eight [three in the upper GI tract and five in the LGI tract], gastric erosions in eight [8%], and angiodysplasia, diverticulitis, and trichuriasis in two [2%] each
Conclusion: In light of the high incidence of GI malignancies in this patient group, a low threshold for GI screening as well as mass screening for IDA is needed