Gastrointestinal Lesions in African American Patients with Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA) is a frequent disorder that is associated with many serious diseases. However, the findings of an evaluation of IDA associated gastrointestinal disorders are lacking among African American patients. Aim: To determine the most prevalent gastrointestinal lesions among African American patients with IDA especially in young men. Methods: We reviewed medical records (n=422) of patients referred for evaluation of IDA from 2008 to 2012. IDA was diagnosed using clinical laboratory tests. The results of esophagogastroduodenoscopy (EGD), colonoscopy and pathology specimens along with demographic data were abstracted and analyzed using STATA. Results: The mean age was 61.9 years, and 50.5% were female. 189 patients (45%) had gross GI bleeding. The most frequent diagnoses were gastritis (40%), benign colonic lesions (13%), esophagitis (9%), gastric ulcer (6%), and duodenitis (6%). By sex, duodenal benign tumors were significantly more represented among females: 4% vs 1% (p=0.05) while left colon malignancy was more prevalent among males: 3% vs 0.05% (p=0.05). Benign and malignant colonic lesions were significantly more present among older patients: 16% vs 6% (P=0.005) and 5% vs 0% (p=0.008), respectively. Colitis was more prevalent in younger patients (=50): 11% vs 2% (p=0.001). In patients with gross lower GI bleeding, the top diagnoses were gastritis (25%), benign colon tumors (10%), and duodenitis (6%). Colon cancer was diagnosed among 15 patients and all these patients were older than 50 years of age. Conclusion: This exploratory analysis of IDA associated GI lesions revealed that gastritis and colonic lesions are most common lesions found among African Americans with IDA with minimal age and sex differences. Colitis was found more in young patients while IDA was more associated with lower GI malignancies in older patients. Upper GI endoscopy might be required if colonoscopy is unrevealing of the cause of IDA.