IRON deficiency was associated with clinically significant gastrointestinal lesions, neoplasia, and malignancy more frequently when accompanied by anaemia, although patients without anaemia also had a measurable risk of serious gastrointestinal disease. These findings highlight the importance of individualised clinical assessment when considering endoscopic investigation for patients with iron deficiency.
A retrospective study conducted at the Gastroenterology Clinic of Ankara Etlik City Hospital, Türkiye, examined the prevalence of clinically significant gastrointestinal lesions, neoplasia, and malignancy in adults with iron deficiency, with and without anaemia. The research also evaluated clinical variables associated with these findings.
The study included 1,160 adults who underwent both upper gastrointestinal endoscopy and colonoscopy following laboratory confirmation of iron deficiency between January 2023 and June 2025. Of these, 553 patients had iron deficiency without anaemia (IDWA), while 607 had iron deficiency anaemia (IDA).
The investigation addressed an important clinical uncertainty regarding the need for endoscopic evaluation in patients with iron deficiency who do not meet the criteria for anaemia. Evidence concerning significant gastrointestinal pathology in this population remains limited, making comparisons between the two groups clinically relevant.
Clinically significant gastrointestinal lesions were identified more frequently in patients with IDA than in those with IDWA, affecting 22.1% and 10.7% of patients, respectively. This difference was statistically significant (p≤0.002).
A similar pattern emerged for gastrointestinal neoplasia, which was reported in 11.0% of patients with IDA compared with 5.8% of those with IDWA. Total gastrointestinal malignancy was also more prevalent among patients with anaemia, affecting 6.6% compared with 2.2% in the group without anaemia. The reported differences across these outcomes were statistically significant (p≤0.002).
Within the IDWA group, male sex was the only independent clinical variable associated with gastrointestinal neoplasia. This finding identifies a potential consideration for risk assessment, although the study abstract does not establish that sex alone should determine whether endoscopy is undertaken.
Despite the lower prevalence of significant gastrointestinal findings in patients without anaemia, the results demonstrate that the absence of anaemia does not exclude gastrointestinal neoplasia or malignancy.
The findings support a risk-based approach to endoscopic investigation in patients with IDWA, rather than relying exclusively on the presence or absence of anaemia. Clinicians should consider individual clinical risk factors when determining whether further gastrointestinal evaluation is appropriate.
Although gastrointestinal lesions and malignancy were more frequent in patients with IDA, the observed disease burden in the IDWA group reinforces the importance of clinical judgement. Further consideration of patient specific risk factors may help guide decisions about investigation in this population.
Reference
Yıldırım T, Deniz DA. Gastrointestinal lesions and malignancy in iron deficiency with and without anaemia. BMC Gastroenterol. 2026;DOI:10.1186/s12876-026-05437-6.
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