LAUSR

BACKGROUND AND AIMS Intestinal diseases are regarded as a common cause of anemia, but the diagnostic outcomes of children with anemia undergoing endoscopic investigations are unclear. We investigated this issue in a large cohort of children. METHODS Indications for and findings of consecutive gastrointestinal endoscopies were collected. Clinical presentation and diagnostic outcomes were compared between anemic and nonanemic patients, and between anemic patients with and without a diagnosis. Diagnoses received during follow-up were collected. RESULTS Out of 2,395 consecutive endoscopies, 251 children with and 613 without anemia had undergone either diagnostic esophagogastroduodenoscopy (51.4% and 51.4% respectively), colonoscopy (4.0% and 11.4%), or both (45.8% and 37.8%). Children with anemia more often received diagnoses (72.9% vs 39.3%; OR, 4.18; 95% CI, 3.03-5.77), particularly of celiac disease (26.3% vs 15.5%, p<0.001) and of inflammatory bowel disease (31.1% vs 9.1%, p<0.001) than did nonanemic children. Diagnosis in anemic patients was predicted by age 5 to 12 years (OR, 3.52; 95% CI, 1.27-9.75), presence of diarrhea (OR, 2.04; 95% CI, 1.07-3.90), melena/hematochezia (OR, 2.40; 95% CI, 1.17-4.92), poor growth (OR, 3.94; 95% CI, 1.70-9.15), positive celiac serology (OR, 11.81; 95% CI, 3.47-40.12), high calprotectin (OR, 12.86; 95% CI, 4.00-41.32), hypersedimentation (OR, 2.65; 95% CI, 1.29-5.44), and hypoalbuminemia (OR, 5.05; 95% CI, 1.56-16.34). Thirty children with anemia (12.0%) had no gastrointestinal symptoms and 22 of them (73.3%) were given diagnoses at the time of the endoscopies. All 22 were seen with additional laboratory abnormalities, whereas these were present in only 2 of the 8 undiagnosed children. None of them were diagnosed later in the follow-up of up to 11 years, in contrast to 4 (6.7%) of all anemic and 33 (8.9%) of nonanemic patients. CONCLUSION Anemia increased the probability of being given a diagnosis, emphasizing its importance as an alarm symptom. However, endoscopies in anemic patients without additional symptoms or laboratory abnormalities seldom improved the diagnostic yield.