Coded Gastrointestinal Diagnoses in Women Aged 18-44 Years with Iron Deficiency Anemia Without Selected Coded Alarm Features Who Underwent Same-Day Bidirectional Endoscopy: A Multicenter U.S. Electronic Health Record Study.

BACKGROUND

The role of bidirectional endoscopy in younger women with iron deficiency anemia (IDA) and no alarm features remains uncertain.

AIMS: To describe gastrointestinal (GI) codes recorded through 3 months after same-day bidirectional endoscopy in women aged 18-44 years with biochemically supported IDA and without selected coded alarm features.

METHODS

We conducted a retrospective descriptive TriNetX study. The first colonoscopy defined index; esophagogastroduodenoscopy was required the same day. An IDA code, hemoglobin ≤12 g/dL, and ferritin ≤45 ng/mL were required within 3 months on or before index. Outcomes were codes recorded from index through 3 months afterward. A sensitivity analysis excluded prior colorectal malignancy and inflammatory bowel disease (IBD) codes.

RESULTS

The cohort included 769 women from 57 organizations (mean age, 37 [SD, 6] years); the condition-specific denominator was 768. Common upper-GI codes were gastritis/duodenitis (343/768, 44.7%), hiatal hernia (84/768, 10.9%), Helicobacter pylori (78/768, 10.2%), and gastric/duodenal ulcer (48/768, 6.3%); no upper-GI malignancy code was recorded. Lower-GI codes included hemorrhoids (246/768, 32.0%), D12-coded benign colorectal/anal neoplasm (93/768, 12.1%), and IBD (67/768, 8.7%). The colorectal malignancy code count was privacy suppressed (1-10/768; ≤1.3%). After excluding prior IBD codes, 13/710 (1.8%) had an IBD code recorded.

CONCLUSIONS

These coded diagnoses cannot be assumed to represent newly detected lesions or causes of IDA. Without a non-endoscoped comparison group, the study cannot establish the benefit of routine or selective endoscopy.