Diagnostic yield of endoscopy in women under 50 with iron deficiency anemia: a retrospective cohort study from Jordan.

Background and aims: Iron deficiency anemia is a serious health issue that is largely prevalent, especially in premenopausal women. Guidelines recommend endoscopic evaluation of these patients even in the absence of symptoms. However, the evidence for this recommendation is weaker than that for postmenopausal women. Our study aimed to determine the diagnostic yield of endoscopic evaluation of women under 50 years with iron deficiency anemia. Methods: We performed a dual-center retrospective cohort study over a period of three years. Consecutive females aged 18-49 years with Hb <12 g/dL and ferritin <45 ng/mL who underwent upper and/or lower endoscopy for iron deficiency anemia were included. Results: We included 300 women [median age 39.0 years (Interquartile range 29.0-45.0) and median Hb of 10.7 g/dL (Interquartile range: 9.3-11.6)]. The vast majority (82.7%) reported gastrointestinal symptoms. Upper endoscopy revealed abnormalities in 79.4% of patients, most commonly gastritis (57.0%). Colonoscopy showed abnormalities in 48.6%, primarily internal hemorrhoids (32.6%). Significant findings were identified in 19.3% of patients, with older age being the only significant predictor. The prevalence of specific diagnoses was 2.0% for celiac disease, 1.7% for inflammatory bowel disease, and 1.3% for colorectal cancer. No clinical variables predicted these specific diagnoses. Conclusion: Endoscopic evaluation of young women with iron deficiency anemia identifies a high burden of gastrointestinal pathology, predominantly in the upper tract. The inability of symptoms or other clinical features to predict significant findings supports a broad referral strategy for endoscopic investigation in this population.