Objective: Our aim was to evaluate the gastrointestinal tract in patients with serum ferritin values ≤50 ng/ml for the presence of serious gastrointestinal pathology, including neoplasia and acid peptic disease. Methods: In this prospective observational study, patients with serum ferritin values ≤ 50 ng/ml who did not have an obvious cause of iron deficiency underwent colonoscopy and/or esophagogastroduodenoscopy. Results: Between October 1, 1994, and February 29, 1996, 725 of 3015 patients who had serum ferritin determinations were found to have values ≤ 50 ng/ml. To date, 143 patients have been fully evaluated and 77 were found to have serious gastrointestinal pathology including acid peptic disease (N = 46), cancer (N = 15), and large adenomas (N = 6). Colon cancer was discovered in five asymptomatic patients. The prevalences of serious gastrointestinal pathology did not differ between patients with serum ferritin values ≤ 20 ng/ml and those with values between 21-50 ng/ml (63% vs 48%, p = 0.07). However, multivariate analysis showed that the presence of upper or lower gastrointestinal symptoms and serum ferritin value ≤20 ng/ml is predictive of finding serious pathology (p = 0.0002 for the whole model), with odds ratios of 3.8 (95% confidence interval of 1.84-7.70) for presence of gastrointestinal symptoms and 2.2 (95% confidence interval of 1.09-4.57) for serum ferritin value ≤ 20 ng/ml. Conclusions: Endoscopic examination is warranted in patients with serum ferritin values ≤ 50 ng/ml to detect serious gastrointestinal pathology, present in 54% of such patients.
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