If you have recently been diagnosed with an iron deficiency anemia, your provider may recommend that you see a gastroenterologist for evaluation. The reason for this is that unless there is a reason for blood loss, such as a recent trauma or surgery or heavy menstrual cycles, the GI tract is the largest organ system to cause blood loss.
Let’s start from the beginning. The World Health Organization defines anemia as a hemoglobin <13.0 in men and <12.0 in women. Anemia can occur when an individual is losing blood, not making blood properly, or not absorbing iron/nutrients properly. There are many sources or causes for bleeding stemming from the gastrointestinal tract. This could be from bleeding colon lesions, like a colon cancer or larger polyp; a malabsorption condition, like celiac disease; or abnormalities with the bleed vessels along the GI tract.
So, where do we start? Once a diagnosis of anemia has been made, you will be brought into the office to see one of our providers. The provider will take a detailed personal and family history and perform an evaluation. The examination will include a physical examination to assess the abdomen, but may also include a rectal exam to see if there are any palpable anorectal lesions or hemorrhoids and test the stool for occult, or hidden, blood. Blood work may also be ordered to further clarify the type of anemia. We often will want to check your iron studies, vitamin levels, and blood making ability. Once we have that information, we can formulate a plan to evaluate the GI tract.
If you are over the age of 50 and have never had colon cancer screening (younger if there is a family history) or if you have any concerning lower GI symptoms, a colonoscopy will be the first test performed. The colonoscopy will evaluate the entire surface space of the colon to assess for polyps, tumors, hemorrhoids, or mucosal abnormalities. If you are not of colon cancer screening age, recently had a colonoscopy, or are having any upper GI symptoms, an endoscopy may be recommended as the first test. The endoscopy will evaluate the esophagus, stomach, and first part of the small bowel (duodenum). A video capsule will evaluate the remainder of the small bowel and may be recommended to finish out the evaluation after the colonoscopy and endoscopy have been performed.
In addition to finding bleeding lesions, celiac disease, or inflammatory processes, we commonly find angiodysplastic lesions in the colon or small bowel. These lesions may also be referred to as AVMs, vascular ectasia, or spider veins. These are swollen, fragile vessels that can easily bleed overtime causing an iron and blood loss. Unless these are actively bleeding at the time of the evaluation, management usually includes iron repletion with oral iron supplements or iron infusions. Sometimes we do not find any source of bleeding in the GI tract. If the evaluation comes up negative, an evaluation by a hematologist, or blood specialist, is usually recommended.
For individuals that cannot tolerate the adverse effects of oral supplements or do not respond appropriately to oral iron repletion, we can perform iron infusions here at Hillmont GI. If iron infusions are determined to be the best treatment for you, you will be brought into our Lansdale office’s infusion center where you will receive two 30 minute iron infusions about two weeks apart.