철분결핍성빈혈에서 내시경검사의 중요성
Significance of Endoscopy in the Investigation of Iron Deficiency Anemia
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목적: 철분결핍성빈혈 환자에서 소화관 출혈이 원인일 수 있어 이의 진단을 위한 내시경검사가 권유되고 있으나 실제로 그 진단적 유용성에 대한 국내의 합의는 없는 실정이다. 이에 본 저자 등은 철분결핍성빈혈환자에서 상부위장관내시경 및 대장내시경검사의 유용성을 알아보고자 본 연구를 시행하였다. 대상 및 방법: 1998년 1월부터 2003년 9월까지 강북삼성병원과 삼성서울병원에서 철분결핍성빈혈을 진단 받은 환자 중 출혈의 소견이 없고 빈혈을 유발할 수 있는 다른 원인이 없는 129명의 환자들(남：여=19：110, 평균나이=43.6)을 대상으로 상부위장관내시경검사와 대장내시경검사를 시행하였다. 결과: 상부위장관내시경검사에서 70% (89예)의 이상소견이 발견되었고 그 중 8.5% (11예)는 의미 있는 소견이었다(역류성식도염 1예, 혈관이형성증 1예, 심한 미란성위염 2예, 위궤양 2예, 십이지장궤양 5예). 대장내시경검사에서 36% (46예)의 이상소견이 발견되었고 그 중 11% (14예)는 의미 있는 소견이었다(1 cm 이상의 선종 2예, 혈관이형성증 1예, 출혈성 치핵 5예, 염증성장질환 4예, 대장암 2예). 결론: 철분결핍성빈혈 환자에서 소화관 질환은 흔히 발견되었고 그중 일부는 철분결핍성빈혈의 원인이 될 수 있는 의미 있는 소견이므로 상부위장관내시경과 대장내시경검사는 필수적일 것으로 생각한다.
Abstract
Background/Aims: There is no consensus for the role of endoscopy in the etiologic investigation of iron deficiency anemia (IDA) in Korea. We carried out a retrospective study to evaluate the role of esophagogastroduodenoscopy (EGD) and colonoscopy for their etiologic diagnosis in IDA. Methods: Between January 1998 and September 2003, 129 patients (male：female=19：110, mean age=43.6) had been grew EGD and colonoscopy for exam for the investigation of IDA at Kangbuk Samsung Hospital and Samsung Medical Center Medical records were retrospectively reviewed: Results: Significant findings were found in 8.5% (11 cases: grade B reflux esophagitis by L.A. classification (1), angiodysplasia (1), severe erosive gastritis (2), and gastric ulcer (2) and duodenal ulcer (5), while 70% (89 cases) showed some abnormality in EGD examination. Significant findings were seen in 11% (14 cases: polyps ＞1 cm (2), angiodysplasia (1), bleeding hemorrhoids (5), inflammatory bowel disease (4) and colon cancer (2)), among 36% (46 cases) of patients with some abnormality in colonoscopy. Conclusions: Gastrointestinal lesions were frequently found in patients with IDA and significant proportion of them could be the source of blood loss. Therefore, EGD and colonoscopy should be included in the evaluation of IDA in Korea.
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