Indications, characteristics, and endoscopic findings for iron deficiency referrals to a tertiary pediatric gastroenterology outpatient service.

Abstract

Background and Aim: Iron deficiency, with or without anemia, is a common indication for a pediatric gastroenterology referral. Iron deficiency is a frequently encountered problem in children, most commonly due to inadequate dietary intake, especially in the context of increased iron requirements during childhood development. Careful dietary review and adequate iron supplementation should resolve most cases. In nonresponders, referral to a pediatric gastroenterology service should be considered for potential endoscopic gastrointestinal evaluation. The aim of this study was to identify all referrals to a pediatric gastroenterology service for iron deficiency and to determine their characteristics and subsequent endoscopic findings. Method(s): We conducted a retrospective review of all referrals to a tertiary pediatric gastroenterology clinic across a 12-month period (January to December 2019). All referrals for iron deficiency were identified, and patients were included if they were hypoferritinemic (according to age and sex) and/or had a reduced transferrin saturation. Patients who did not attend for outpatient review were excluded from the audit. Baseline characteristics, iron studies, full blood examination, and endoscopy reports were recorded. Endoscopic diagnoses were categorized into celiac disease, inflammatory bowel disease (IBD), gastritis/Helicobacter pylori infection, reflux esophagitis, or no endoscopic cause for iron deficiency. Result(s): A total of 646 referrals in the 12-month period were screened. From these, 42 referrals for isolated iron deficiency were identified. Nine patients were excluded as they did not attend an appointment or were seen at an alternative hospital service, so 33 patients were included in this audit. Sixteen patients (48.5%) were male, with a mean age of 8.7 +/- 5.5 years. The mean ferritin level was 23.8 +/- 70 mug/L, and the median ferritin level was 9 mug/L (IQR, 5.8-15). The mean transferrin saturation was 9.3 +/- 6.3%. The mean hemoglobin level was 112.5 +/- 16.7 g/L, and 14 patients (42.4%) were anemic (according to age and sex). In total, 20 patients (60.6%) were referred for endoscopy after clinical assessment: 17 for gastroscopy only and three for combined gastroscopy and colonoscopy. Of these 20 patients, 14 (70%) had a positive finding on their endoscopy: six with celiac disease, four with gastritis/H. pylori infection, three with IBD, and one with reflux esophagitis. Most of them had history and/or noninvasive investigations suggestive of their underlying disease. Conclusion(s): Pediatric iron deficiency is a common reason for referral to our gastroenterology service. There was significant variation in ferritin levels, with elevated levels driven by inflammatory states. Clinical evaluation by a pediatric gastroenterologist with the support of noninvasive investigations appears to be valuable in selecting patients who may benefit from endoscopic evaluation.