What are the recommendations for endoscopy in patients presenting with confirmed IDA?¶
Answer: Postmenopausal women and all men with confirmed iron deficiency (ID) or IDA should undergo bidirectional endoscopy; in premenopausal women the decision is individualized.
- Postmenopausal women and men — bidirectional endoscopy, consistent with multiple other organizations (strong recommendation, moderate quality of evidence).
- Premenopausal women — the AGA still suggests bidirectional endoscopy over iron replacement alone, but this is a conditional recommendation (moderate quality of evidence):
In asymptomatic premenopausal women with iron deficiency anemia, the AGA suggests bidirectional endoscopy over iron replacement therapy only.
Comment: Patients who place a high value on avoiding the small risk of endoscopy, particularly those who are young and might have other plausible reasons for IDA, and a low value on the very small risk of missing a gastrointestinal malignancy would reasonably select an initial course of iron replacement therapy and no initial bidirectional endoscopy.
- Our approach in premenopausal women: identify and correct abnormal vaginal bleeding and re-assess at a short interval of 3–6 months. If IDA persists or other red flags are present, proceed with endoscopy.
Source: AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia