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Iron deficiency anemia & GI My highlights/takeaways on the new AGA guidelines
https://pubmed.ncbi.nlm.nih.gov/32810434/
Questions it tackles:
How to dxWho to scopeWhen to bxWhat to do if eval 
- How to dx
Recommendation: Use Ferritin cut off 45 instead of 15
Strong rec 
High quality evidenceCut off 45 - sensitivity 85 specificity 92
Cut off 15 - sensitivity 59 sensitivity 99
Cut off of 45 
sensitivity of test for IDA, modest 
specificity
Who to scopeRecommendation: bidirectional endoscopy for post menopausal women 
and men 
with IDAStrong rec 
Moderate evidence
Who to scope 
Conditional recommendation: premenopausal asymptomatic, can consider bidirectional endoscopy over iron aloneConditional rec, Moderate evidence
Reasonable to treat IDA empirically:
Wishing to avoid tests YoungOther explanations for IDA
When to biopsyEvidence gets less
Conditional rec, low quality evidence: Unexplained IDA after scope, rec noninvasive H. pylori testing over gastric bx and tx if positive
3 RCT showed > increase in hgb in those treated after identification
or UBT 
cost savings
When to bx 
Very low quality evidence, conditional recommendationIf plausible celiac dz, serology and bx only if 
instead of routine bxSuggests against routine gastric bx to diagnose atrophic gastritis
What to do if eval 
Very low qual evidence, conditional recUncomplicated and asymptomatic pt with IDA and negative endoscopy, consider iron tx over capsule
Caution in pt with comorbidities or if if will change mgmt anticoagulation/antiplatelet
My take:
Ferritin cut off of 45 makes a lot of sense
Further endorses common practice of endoscopy for post menopausal and with IDA
As with most of medicine, much is conditional and based on shared decision making w pt
What is your take, #GITwitter ?
Ferritin cut off of 45 makes a lot of sense Further endorses common practice of endoscopy for post menopausal and with IDAAs with most of medicine, much is conditional and based on shared decision making w ptWhat is your take, #GITwitter ?
Appreciate the excellent guidance from @AmerGastroAssn in this common clinical scenario!
