Iron deficiency anemia (IDA), mostly due to chronic occult bleeding from the gastrointestinal tract, is a common problem in the elderly. This study aimed to determine the prevalence of IDA in the elderly and to investigate the gastrointestinal tract in elderly patients with IDA. 1,388 patients over 65 years were prospectively evaluated for IDA in our outpatient clinic. IDA was defined if decreased hemoglobin concentrations (<13 g/dl for men and <12 g/dl for women) were associated with low serum ferritin levels (<15 ng/ml in men and <9 ng/ml in women). We evaluated the gastrointestinal system of all patients with IDA by upper gastrointestinal endoscopy and colonoscopy regardless of fecal occult blood loss. The prevalence of anemia was found to be 25% (n = 347) in our study population, and 30.5% (n = 106) of these patients with anemia had iron deficiency. Upper gastrointestinal endoscopy and colonoscopy were performed in 96 patients with IDA. Fifty-eight upper gastrointestinal system lesions (55 patients, 57.3%) and 27 colonic lesions (26 patients, 27.1%) were detected. We diagnosed gastrointestinal malignancy in 15 (15.6%) elderly patients with IDA (8 colon, 1 esophageal and 6 gastric cancers). IDA is a common problem in elderly patients; consequently, before iron replacement therapy, patients should be thoroughly investigated regarding a possible association with gastrointestinal malignancy.

1.
Smith DL: Anemia in the elderly. Am Fam Physician 2000;62:1565–1572.
2.
Ania BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ 3rd: Incidence of anemia in older people: An epidemiologic study in a well defined population. J Am Geriatr Soc 1997;45:825–831.
3.
Joosten E, Pelemans W, Hiele M, Noyen J, Verhaeghe R, Boogaerts MA: Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology 1992;38:111–117.
4.
Murphy PT, Hutchinson RM: Identification and treatment of anaemia in older patients. Drugs Aging 1994;4:113–127.
5.
Scott RB: Common blood disorders: A primary care approach. Geriatrics 1993;48:72–76.
6.
Moses PL, Smith RE: Endoscopic evaluation of iron deficiency anaemia. A guide to diagnostic strategy in older patients. Postgrad Med 1995;98:213–216.
7.
Kepczyk T, Kadakia SC: Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Dig Dis Sci 1995;40:1283–1289.
8.
Ania BJ, Suman VJ, Fairbanks VF, Melton LJ 3rd: Prevalence of anemia in medical practice: Community versus referral patients. Mayo Clin Proc 1994;69:730–735.
9.
Salive ME, Cornoni-Huntley J, Guralnik JM, Phillips CL, Wallace RB, Ostfeld AM, Cohen HJ: Anemia and hemoglobin levels in older persons: Relationship with age, gender, and health status. J Am Geriatr Soc 1992;40:489–496.
10.
Daly MP: Anemia in the elderly. Am Fam Physician 1989;39:129–136.
11.
Freedman ML, Sutin DG: Blood disorders and their management in old age; in Tallis R, Fillit H, Brocklehurst JC (eds): Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, ed 5. London, Churchill Livingstone, 1998, pp 1247–1291.
12.
Chernetsky A, Sofer O, Rafael C, Ben-Israel J: Prevalence and etiology of anemia in an institutionalized geriatric population. Harefuah 2002;141:591–594.
13.
Spyckerelle Y, Piette F, Steinmetz J, Fournier B, Bussy C, Giardanella JP, Boulange M: Iron deficiency in patients over 60 years. Descriptive study in the consultant population of health screening centers. Gastroenterol Clin Biol 2000;24:709–713.
14.
Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL: Prevalence of iron deficiency in the United States. JAMA 1997;277:973–976.
15.
Mukhopadhyay D, Mohanaruban K: Iron deficiency anaemia in older people: Investigation, management and treatment. Age Ageing 2002;31:87–91.
16.
Rockey DC, Cello JP: Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 1993;329:1691–1695.
17.
Zuckerman G, Benitez J: A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol 1992;87:62–66.
18.
Gordon SR, Smith RE, Power GC: The role of endoscopy in the evaluation of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol 1994;89:1963–1967.
19.
Till SH, Grundman MJ: Prevalence of concomitant disease in patients with iron deficiency anaemia. BMJ 1997;314:206–208.
20.
El-Serag HB, Graham DY, Richardson P, Inadomi JM: Prevention of complicated ulcer disease among chronic users of nonsteroidal anti-inflammatory drugs: The use of a nomogram in cost-effectiveness analysis. Arch Intern Med 2002;162:2105–2110.
21.
Domschke S, Domschke W: Gastroduodenal damage due to drugs, alcohol and smoking. Clin Gastroenterol 1984;13:405–436.
22.
Schilling D, Griger G, Weidmann E, Adamek HE, Benz C, Rieman JF: Long-term follow-up of patients with iron deficiency anemia after a close endoscopic examination of the upper and lower gastrointestinal tract. Z Gastroenterol 2000;38:827–831.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.