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Peer-reviewedCC BY 4.0Cureus

Association Between Iron-Deficiency Anemia and Endoscopic Findings in Patients Undergoing Upper Gastrointestinal (GI) Endoscopy

  • Asma Khan1,2
  • Muhammad Ayhan Amir3,4
  • Medhini Roy Bhojanapu5
  • Shah Jahan6,4
  • Mina Wahib7
  • Kingsley Chisom Ugwuanyi8,9
  • Quratulain Tanveer10,11
  • Abdullah Najam12,4
  • Nasmina Ferdausi Choudhury13
  • Rebecca Roberts14
14 affiliations
  1. 1Hematology, Services Institute of Medical Sciences, Lahore, PAK
  2. 2Hematology, East Kent Hospitals University NHS Foundation Trust, Canterbury, GBR
  3. 3Internal Medicine, Shifa Tameer-e-Millat University, Shifa College of Medicine, Islamabad, PAK
  4. 4Internal Medicine, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
  5. 5Medicine, Government Medical College and Hospital, Nizamabad, IND
  6. 6Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
  7. 7Internal Medicine, Pinderfields Hospital, The Mid Yorkshire Teaching NHS Trust, Wakefield, GBR
  8. 8Emergency Medicine, Enugu State University of Science and Technology, Enugu, NGA
  9. 9Emergency Medicine, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR
  10. 10Gastroenterology, Shaikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
  11. 11Gastroenterology, Diana Princess of Wales Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Grimsby, GBR
  12. 12Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
  13. 13Internal Medicine, Northern State Medical University, Arkhanglesk, RUS
  14. 14Internal Medicine, North Bristol NHS Trust, Bristol, GBR
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Abstract

Background: Iron-deficiency anemia (IDA) may be associated with underlying gastrointestinal pathology. This study examined the association between IDA and upper gastrointestinal endoscopic findings and described the range of endoscopic abnormalities in patients with IDA.

Methods: A prospective observational cross-sectional study involving 570 adults who underwent upper gastrointestinal endoscopy. We collected biological, clinical, demographic, hematological, and iron-profile data. We defined IDA as anemia according to sex-specific hemoglobin thresholds accompanied by a serum ferritin concentration of <15 ng/mL. We categorized participants as having IDA or no IDA and compared endoscopic findings between groups. We used multivariable logistic regression to identify independent factors for an abnormal endoscopy.

Results: IDA was found in 259 (45.4%) participants, and abnormal upper gastrointestinal endoscopy was detected in 376 (66.0%). Abnormal findings were more frequent among participants with IDA (211 (81.5%)) than those without IDA (165 (53.1%); OR: 3.89; 95% CI: 2.65-5.71; p < 0.001). After adjustment, IDA was independently associated with abnormal endoscopy (adjusted OR: 3.875; 95% CI: 2.617-5.738; p < 0.001). After adjustment, IDA remained independently associated with esophagitis (aOR: 2.46; 95% CI: 1.43-4.22), gastritis (aOR: 1.91; 95% CI: 1.30-2.80), gastric ulcer (aOR: 2.69; 95% CI: 1.53-4.72), and duodenal ulcer (aOR: 2.71; 95% CI: 1.36-5.40). Nonsteroidal anti-inflammatory drug (NSAID) use was independently associated with abnormal endoscopy (adjusted OR: 1.766; 95% CI: 1.078-2.894; p = 0.024).

Conclusions: IDA was strongly associated with abnormal endoscopic findings in the upper gastrointestinal tract, especially inflammatory and ulcerative lesions. These findings support the clinical relevance of upper gastrointestinal evaluation among appropriately selected patients with IDA.

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Cite

BibTeXRIS
BibTeX
@article{khan2026association,
  title = {{Association Between Iron-Deficiency Anemia and Endoscopic Findings in Patients Undergoing Upper Gastrointestinal (GI) Endoscopy}},
  author = {Asma Khan and Muhammad Ayhan Amir and Medhini Roy Bhojanapu and Shah Jahan and Mina Wahib and Kingsley Chisom Ugwuanyi and Quratulain Tanveer and Abdullah Najam and Nasmina Ferdausi Choudhury and Rebecca Roberts},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117713},
  url = {https://doi.org/10.7759/cureus.117713},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association Between Iron-Deficiency Anemia and Endoscopic Findings in Patients Undergoing Upper Gastrointestinal (GI) Endoscopy
AU  - Asma Khan
AU  - Muhammad Ayhan Amir
AU  - Medhini Roy Bhojanapu
AU  - Shah Jahan
AU  - Mina Wahib
AU  - Kingsley Chisom Ugwuanyi
AU  - Quratulain Tanveer
AU  - Abdullah Najam
AU  - Nasmina Ferdausi Choudhury
AU  - Rebecca Roberts
PY  - 2026
DA  - 2026/10/09
JO  - Cureus
DO  - 10.7759/cureus.117713
UR  - https://doi.org/10.7759/cureus.117713
AB  - Background: Iron-deficiency anemia (IDA) may be associated with underlying gastrointestinal pathology. This study examined the association between IDA and upper gastrointestinal endoscopic findings and described the range of endoscopic abnormalities in patients with IDA.  Methods: A prospective observational cross-sectional study involving 570 adults who underwent upper gastrointestinal endoscopy. We collected biological, clinical, demographic, hematological, and iron-profile data. We defined IDA as anemia according to sex-specific hemoglobin thresholds accompanied by a serum ferritin concentration of <15 ng/mL. We categorized participants as having IDA or no IDA and compared endoscopic findings between groups. We used multivariable logistic regression to identify independent factors for an abnormal endoscopy.  Results: IDA was found in 259 (45.4%) participants, and abnormal upper gastrointestinal endoscopy was detected in 376 (66.0%). Abnormal findings were more frequent among participants with IDA (211 (81.5%)) than those without IDA (165 (53.1%); OR: 3.89; 95% CI: 2.65-5.71; p < 0.001). After adjustment, IDA was independently associated with abnormal endoscopy (adjusted OR: 3.875; 95% CI: 2.617-5.738; p < 0.001). After adjustment, IDA remained independently associated with esophagitis (aOR: 2.46; 95% CI: 1.43-4.22), gastritis (aOR: 1.91; 95% CI: 1.30-2.80), gastric ulcer (aOR: 2.69; 95% CI: 1.53-4.72), and duodenal ulcer (aOR: 2.71; 95% CI: 1.36-5.40). Nonsteroidal anti-inflammatory drug (NSAID) use was independently associated with abnormal endoscopy (adjusted OR: 1.766; 95% CI: 1.078-2.894; p = 0.024).  Conclusions: IDA was strongly associated with abnormal endoscopic findings in the upper gastrointestinal tract, especially inflammatory and ulcerative lesions. These findings support the clinical relevance of upper gastrointestinal evaluation among appropriately selected patients with IDA.
SN  - 2168-8184
ER  -