614 Bidirectional Endoscopy in Premenopausal Women With Asymptomatic-Iron Deficiency Anemia (A-IDA)

INTRODUCTION: GI investigation of premenopausal women with A-IDA is a controversial subject with some societal guidelines recommending initially only celiac or Helicobacter pylori (HP) screening instead of upper (U) and lower (L) GI endoscopy. The aim of this study was to determine the relative frequencies of associated GI sources of A-IDA in premenopausal women who underwent bidirectional endoscopy (BDE). METHODS: We performed a retrospective chart review noting clinical characteristics of asymptomatic premenopausal women who had BDE performed within 6 months of IDA diagnosis between the yrs 2014-2019. Pts were excluded if they had GI tract surgery within 10 yrs, active pregnancy, active GI bleeding, an obvious site of non-GI blood loss or ferritin >100. McNemar's test was used to compare frequency of UGI and LGI lesions. Bivariate analyses of characteristics associated with UGI and LGI lesions were performed using t-test, Chi-squared test, or Fisher's exact test. Multivariate logistic regression models estimated odds ratios. RESULTS: Records of 98 premenopausal female pts were available for analysis (mean age 44 yrs; Table 1). BDE revealed lesions associated with IDA in 61 pts (62.2%) comprising 41 (41.8%) UGI lesions, 10 (10.2%) LGI lesions, and 7 (7.1%) both UGI and LGI lesions. In our cohort, UGI lesions were more common than LGI lesions [48 (49%) vs 17 (17%); P < 0.001]. Predictors of an UGI lesion included NSAIDS use [OR 3.60 (95% CI 1.36-10.25); P = 0.01] and HP infection [OR 5.4 (2.20-14.24); P < 0.001]. No significant predictors of LGI lesions were identified (Table 1). The most common UGI lesions were HP -associated gastritis (35.6%) and peptic ulcer disease (15.3%) (Figure 1a). The most common LGI lesions were large polyps (45%) and hemorrhoids (35%) (Figure 1b). CONCLUSION: Our results indicate 1) premenopausal women often have a GI-associated source of A-IDA; 2) premenopausal women with A-IDA are more likely to have an UGI than LGI source for blood loss; thus starting with UGI endoscopy may be prudent 3) H. pyloriinfection and NSAID use predict UGI lesions associated with A-IDA in premenopausal women.