Indications, characteristics and endoscopic findings for iron deficiency referrals to a tertiary paediatric gastroenterology outpatient service. [Journal of Pediatric Gastroenterology and Nutrition]

Abstract

Objectives and Study: Iron deficiency with or without anaemia is a common indication for a paediatric gastroenterology referral. Iron deficiency is a frequently encountered issue 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 address the majority of cases. In non-responders however, referral to a paediatric gastroenterology service should be considered for potential endoscopic evaluation of gastrointestinal pathology. The purpose of this study was to identify all referrals for iron deficiency to a paediatric gastroenterology service and determine their characteristics and subsequent endoscopic findings. Method(s): We conducted a retrospective review of all referrals to a tertiary paediatric gastroenterology clinic across a 12-month period (January to December 2019). All referrals for iron deficiency were identified and included if they were hypoferritinaemic (according to age and gender) and/or had a reduced transferrin saturation. Patients who did not attend for outpatient review were excluded from the audit. Baseline characteristics, iron studies and full blood examination and endoscopy reports were recorded. Endoscopic diagnoses were categorised into coeliac disease, inflammatory bowel disease (IBD), gastritis/Helicobacter pylori infection, reflux oesophagitis or no endoscopic cause for iron deficiency. Result(s): 646 referrals were screened in the 12-month period. 42 referrals for iron deficiency were identified, 9 patients were excluded as they did not attend an appointment or were seen at an alternative hospital service. Overall 33 patients were included in this audit. 16 (48.5%) patients were male with a mean age of 8.7 +/- 5.5 years. The mean ferritin was 23.8 +/- 70 mu g/L, whilst the median ferritin was 9 mu g/L (IQR 5.8-15). The mean transferrin saturation was 9.3 +/- 6.3%. The mean Haemoglobin was 112.5 +/- 16.7 g/L and 14 (42.4%) patients were anaemic (according to age and gender). In total, 20 (60.6%) patients were referred for endoscopy following clinical assessment. 17 were for gastroscopy only and 3 were for combined gastroscopy and colonoscopy. 14/20 (70%) of the patients had a positive finding on their endoscopy, consisting of 6 with coeliac disease, 4 with gastritis/H.pylori infection, 3 with IBD and 1 with reflux oesophagitis. Conclusion(s): Paediatric iron deficiency is a common referral to our gastroenterology service. There was significant variation in ferritin levels, with elevated levels driven by inflammatory states. Clinical evaluation by a paediatric gastroenterologist appears to be valuable in selecting patients who may benefit from endoscopic evaluation.