{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:05:23Z","timestamp":1783080323883,"version":"3.54.6"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"945","license":[{"start":{"date-parts":[[2004,7,1]],"date-time":"2004-07-01T00:00:00Z","timestamp":1088640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background: Iron deficiency anaemia (IDA) may be a sign of significant gastrointestinal disease, and delayed diagnosis may result in chronic morbidity. Studies in patients referred to hospital for investigation of their anaemia have shown that 5%\u201315% have a gastrointestinal cancer but there are few studies of patients presenting to primary care. Factors influencing further investigation in these patients have not previously been identified.<\/jats:p>\n               <jats:p>Patients and methods: A cohort of patients presenting to their general practitioners (GPs) with IDA was identified and clinical outcomes recorded. Logistic regression was used to determine which factors influenced GPs to investigate the anaemia.<\/jats:p>\n               <jats:p>Results: 43% of patients had investigations within three months and serious pathology was found in 30% of these; 13% of patients were considered unfit for further investigation and 8% refused to have any. Independent predictors of non-investigation were a mild anaemia (odds ratio (OR) 0.38, confidence interval (CI) 0.23 to 0.61, p&amp;lt;0.001), female gender (OR 0.49, CI 0.3 to 0.8, p = 0.004), a previous history of anaemia (OR 0.39, CI 0.24 to 0.64, p&amp;lt;0.001), and age &amp;lt;65 years (OR 0.44, CI 0.26 to 0.74, p = 0.002). During the entire study period gastrointestinal cancer was diagnosed in 48 patients (11%); 17% of men had colorectal cancer. Of 263 patients alive at 12 months without a confirmed diagnosis, 113 (43%) had recurrent or persistent anaemia during the study period.<\/jats:p>\n               <jats:p>Conclusion: Although the overall prevalence of gastrointestinal cancer in patients presenting to primary care is similar to that seen in secondary care, the diagnosis may be delayed due to lack of appropriate investigations resulting in significant morbidity.<\/jats:p>","DOI":"10.1136\/pgmj.2003.015677","type":"journal-article","created":{"date-parts":[[2004,7,14]],"date-time":"2004-07-14T17:30:51Z","timestamp":1089826251000},"page":"405-410","source":"Crossref","is-referenced-by-count":54,"title":["Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations"],"prefix":"10.1093","volume":"80","author":[{"given":"J M","family":"Yates","sequence":"first","affiliation":[{"name":"King\u2019s Mill Hospital, Sherwood Forest Hospitals NHS Trust , Sutton-in-Ashfield, Nottinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E C M","family":"Logan","sequence":"additional","affiliation":[{"name":"King\u2019s Mill Hospital, Sherwood Forest Hospitals NHS Trust , Sutton-in-Ashfield, Nottinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R M","family":"Stewart","sequence":"additional","affiliation":[{"name":"Chesterfield and North Derbyshire Royal Hospital , Chesterfield, Derbyshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2004,7,14]]},"reference":[{"key":"2023050810343718300_R1","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1136\/gut.46.suppl_4.iv1","article-title":"Guidelines for the management of iron deficiency anaemia","volume":"46","author":"Goddard","year":"2000","journal-title":"Gut"},{"key":"2023050810343718300_R2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1136\/bmj.318.7177.164","article-title":"Coeliac disease in primary care: case finding study","volume":"318","author":"Hin","year":"1999","journal-title":"BMJ"},{"key":"2023050810343718300_R3","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1136\/gut.34.10.1427","article-title":"Iron deficiency anaemia\u2014how far to investigate?","volume":"34","author":"Sahay","year":"1993","journal-title":"Gut"},{"key":"2023050810343718300_R4","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1136\/bmj.292.6532.1380","article-title":"Gastrointestinal investigation of iron deficiency anaemia","volume":"292","author":"Cook","year":"1986","journal-title":"BMJ"},{"key":"2023050810343718300_R5","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1056\/NEJM199312023292303","article-title":"Evaluation of the gastrointestinal tract in patients with iron-deficiency anaemia","volume":"329","author":"Rockey","year":"1993","journal-title":"N Engl J Med"},{"key":"2023050810343718300_R6","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1136\/gut.34.8.1102","article-title":"Prospective survey of investigations in outpatients referred with iron deficiency anaemia","volume":"34","author":"McIntyre","year":"1993","journal-title":"Gut"},{"key":"2023050810343718300_R7","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S0002-9343(97)00168-X","article-title":"Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs","volume":"103","author":"Wilcox","year":"1997","journal-title":"Am J Med"},{"key":"2023050810343718300_R8","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/S0002-9343(99)00162-X","article-title":"Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient","volume":"107","author":"Joosten","year":"1999","journal-title":"Am J Med"},{"key":"2023050810343718300_R9","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1136\/pmj.76.894.218","article-title":"Audit of the investigation of iron deficiency anaemia in a district general hospital, with sample guidelines for future practice","volume":"76","author":"Willoughby","year":"2000","journal-title":"Postgrad Med J"},{"key":"2023050810343718300_R10","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1136\/pmj.78.923.533","article-title":"Investigation and management of iron deficiency anaemia in general practice: a cluster randomised trial of a simple management prompt","volume":"78","author":"Logan","year":"2002","journal-title":"Postgrad Med J"},{"key":"2023050810343718300_R11","volume-title":"Mortality statistics, general, 1999","author":"Office for National Statistics","year":"2001"},{"key":"2023050810343718300_R12","volume-title":"Referral guidelines for suspected cancer","author":"Department of Health","year":"2000"},{"key":"2023050810343718300_R13","volume-title":"Morbidity statistics from general practice. 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