Gastrointestinal Endoscopic Findings in Men with Unexplained Anemia and Low Normal Ferritin Values

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Most practice guidelines recommend endoscopic evaluation of the gastrointestinal (GI) tract in men and postmenopausal women with anemia and a serum ferritin less than 20-40 ng/ml. The diagnostic yield of endoscopy in patients with anemia, no GI symptoms or signs, and low normal ferritin is not known.


The aim of this study was to investigate the yield of upper and lower GI endoscopic evaluations in anemic patients with ferritin levels between 40 and 100 ng/ml. Design: A retrospective review of patients' charts was conducted.

Subjects and methods:

Patients at the Veterans Affairs Connecticut Healthcare System who underwent GI endoscopic evaluation for the sole indication of anemia and ferritin in the low normal range (40-100 ng/ml) were included in this study.


Incidence of pathology of the upper and lower GI tract was determined. Results: We identified 54 male patients who had a ferritin level of 40-100 ng/ml and no GI symptoms or known GI bleeding. Upper GI findings (malignancy, peptic ulcers, Helicobacter pylori gastritis, arteriovenous malformations) were found in 14/47 cases (30%). Lower gastrointestinal findings, including large tubular adenomas and arteriovenous malformation, were identified in 3/53 cases (6.7%).


Our study supports GI endoscopy in anemic patients with ferritin between 40 and 100 ng/ml, even in the absence of GI symptoms or documented bleeding.

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