Iron-deficiency anemia
Also known as: anemia · IDA · microcytic anemia
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AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia
American Gastroenterological Association (AGA) · 2020
A US specialty-society guideline that covers how adults found to have iron deficiency anemia should be worked up for a gastrointestinal cause. It addresses laboratory confirmation of iron deficiency and which patients warrant endoscopic investigation. Note: the American Society of Hematology has an iron deficiency anemia guideline in development but, as of this record, had not published it, so the AGA document is listed as the current US authority for the diagnostic pathway.
- Scope is the gastrointestinal evaluation of patients already identified as having iron deficiency anemia, rather than iron replacement therapy itself. source
- Addresses which ferritin threshold to use when confirming iron deficiency and when bidirectional endoscopy is indicated. source
- Published in Gastroenterology, volume 159, pages 1085-1094 (September 2020); lead author Cynthia W. Ko. source
British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults
British Society of Gastroenterology (BSG) · 2021 · 2021 update
A UK/European society guideline covering the whole pathway for adult iron deficiency anaemia: confirming iron deficiency, investigating the underlying cause (including gastrointestinal and small-bowel assessment), and choosing between oral and intravenous iron replacement. The BSG page notes the document is scheduled for update and that separate 2025 BSG/ACPGBI guidance now covers the role of faecal immunochemical testing in investigating iron deficiency anaemia.
- Covers clinical assessment, investigation of the underlying cause, and iron replacement by oral or intravenous route in adults. source
- Updates the society's earlier 2011 guideline and is flagged on the BSG site as due for review. source
- Published in the journal Gut in 2021 (volume 70, pages 2030-2051), lead author J. Snook. source
US vs EU key differences
- Ferritin thresholds are framed differently: the AGA makes a strong recommendation to diagnose iron deficiency at ferritin <45 ng/mL (sensitivity ~85%, specificity ~92%), whereas the BSG describes a tiered interpretation in which <15 µg/L means absent stores and <30 µg/L suggests low reserves, noting only that 45 µg/L discriminates better in practice. source
- Premenopausal women are handled differently: the AGA conditionally extends bidirectional endoscopy to asymptomatic premenopausal women with shared decision making, while the BSG reserves first-line gastroscopy plus colonoscopy for men and postmenopausal women. source
- Sequencing of non-invasive tests differs: the AGA recommends H. pylori and coeliac testing before bidirectional endoscopy and advises against routine gastric or duodenal biopsies when those tests are negative, whereas the BSG recommends coeliac screening serologically or by small-bowel biopsy taken at the time of gastroscopy. source
- Small-bowel evaluation differs: the AGA recommends a trial of iron supplementation before proceeding to video capsule endoscopy in uncomplicated cases, while the BSG names capsule endoscopy as the preferred small-bowel test once bidirectional endoscopy is negative and the anaemia recurs or fails to respond. source
- The BSG explicitly states there are insufficient grounds to use faecal immunochemical testing for risk stratification in iron-deficiency anaemia; the AGA guideline does not address FIT in this setting. source
What changed recently
- EU2011 → 2021 update2021-09-01
This revision of the 2011 BSG guideline moved oral iron replacement to a lower, once-daily (or alternate-day) dosing schedule rather than the older two-to-three-times-daily regimens, and reworked the diagnostic pathway for who needs bidirectional endoscopy and coeliac serology in confirmed iron deficiency anaemia.
source ↗curation confidence 90%
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