Endoscopic evaluation for refractory cases of iron deficiency anemia in children: experience in Zagazig university hospital

ABSTRACT

Iron deficiency anemia [IDA] is the most frequently cause of anemia worldwide. Also, it may be a sign of underlying serious diseases especially if refractory to iron therapy. The aim of this study was to investigate the incidence of GIT pathological findings in symptomatic infants and children with refractory iron deficiency anemia. This study was performed in Pediatric University Hospital during the period from October 2009 to February 2011 on children presented with symptomatic iron deficiency anemia. It included 31 children [18 males, 13 females] with mean age 3.87 +/- 2.3 years. Complete blood counts [CBC], serum iron and serum ferritin were tested. They were treated with iron for 3 months. Further studies were done after failed response. Endoscopic evaluation was done and the cases were treated and re investigated after another 3 months of etiological treatment. Nine patients had cow milk allergy, 8 with Helicobacter pylori [H. pylori] infection, 5 had gastro esophageal reflux disease [GERD], 3 had diaphragmatic hernia, 3 had parasitic infestations, 2 had Celiac disease and 1 patient was diagnosed as peptic ulcer. All of them presented with pallor, 25 patients had abdominal pain, 13 had vomiting, 12 had failure to thrive,11 had abdominal distension,10 had chronic diarrhea,6 had wheezy chest and 5 patients presented with hematemesis. By endoscopic evaluation 12 patients with non specific oesphagitis showed inflammatory changes in the lower end of oesphagus,5 Helicobacter infected subjects with antral nodularity with gastritis, 3 Helicobacter infected subjects with gastritis without nodularity. The three patients with parasitic infestations showed superficial colonic erosions, 2 patients of Celiac disease had duodenal mucosal abnormalities, while one patient showed duodenal ulceration. There was a highly significant difference in the studied patients before and after treatment of the cause regarding serum iron, ferritin level, hemoglobin, mean cell volume [MCV] and mean cell hemoglobin concentration [MCHC]. Anemic children should not be treated blindly with hematinics. They must be investigated to find out the cause and, type of anemia before starting treatment. GIT endoscopy should be considered in the evaluation of IDA expressing digestive complaints or in those with IDA refractory to iron supplementation