Georghegan, M.; Kumar, S.; Bowler, L.; Ishaq, S.; Singh P., P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA109
Academic Journal
Introduction: Iron deficiency anaemia (IDA) is often not approprib ately investigated. Incomplete work up and unacceptable delay in its investigation may lead to poor outcome. Methods: General practitioners and consultants were offered a nurse led, fast track service for gastrointestinal investigation of IDA. The nurse specialist completed a proforma based on a telephone call and/or a clinic consultation. IDA was defined as haemoglobin < 13 gm/dl For men and < 12 gm/dl for women, with at least one of the following: ferritin < 20 ug/I; MCV < 76fl; transferrin saturation index < 10%. In asymptomatic patients aged over 45, the initial investigation was colonoscopy. Oesophagogastroduodenoscopy (OGD) was the first investigation in younger subjects. In symptomatic patients, the nature of symptoms determined the sequence of investigation. If the initial endoscopic investigation failed to reveal an acceptable cause of IDA (cancer, coeliac disease, and inflammatory bowel disease), the patient went on to have endoscopy of the other end of the digestive tract. Results: 90 patients were referred during first 9 months. 72 were eligible for analysis (inappropriate referral = 9, defaulters = 9). 67 had investigations as per protocol and 5 attended for part of the investigative process. The median age was 68 years (range 22 to 91). There were 22 men and 50 women. 47 patients had colonoscopy as first investigation, 1 had barium enema. 38 of 40 without serious colonic disease then had OGD. 24 had OGD first. 19 of 23 without serious upper Gl disease then had colonoscopy. The median interval from initial referral was 6 weeks to the first endoscopic procedure and 9 weeks to the end of the diagnostic process. 21 patients had 22 serious pathologies (colorectal cancer = 8, upper Gl cancer = 4, advanced colonic adenoma = 4, coeliac disease = 3, IBD = 2, caecal ulcer = 1). 12 had 13 less serious diagnoses (oesophagitis = 5, oesophageal stricture = 2, Barrett's metaplasia = 2, small...


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