{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:54:37Z","timestamp":1791651277139,"version":"4.3.4"},"reference-count":28,"publisher":"Walter de Gruyter GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2025-0154_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The diagnostic value of upper endoscopy (EGD) in asymptomatic patients with iron deficiency anemia (IDA) remains uncertain, given the low prevalence of upper gastrointestinal (GI) malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0154_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study comparing asymptomatic patients with laboratory-confirmed IDA to asymptomatic controls referred for pre-bariatric endoscopy. Between-group comparisons assessed demographic, procedural, and endoscopic features. Diagnostic yield was evaluated for clinically significant findings (CSFs) and histologically confirmed malignancy. Diagnostic efficiency was expressed as the number needed to investigate (NNTI). Predictors of CSF and malignancy were identified by multivariable logistic regression, and receiver operating characteristic (ROC) analysis determined optimal age cutoffs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0154_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 6,185 IDA patients and 2,010 controls, endoscopic pathology was significantly more frequent in the anemia group. Major CSFs were detected in 8.2\u202f% of IDA patients vs. 2.9\u202f% of controls (p&lt;0.0001), while malignancy occurred in 1.3 vs. 0.1\u202f% (p&lt;0.0001). Diagnostic efficiency was superior in IDA (NNTI\u02dc12 for CSF; &lt;100 for malignancy) compared with controls (&gt;30 and &gt;1,000, respectively). In adjusted models, IDA and age\u00a0\u226550\u00a0years independently predicted CSFs and malignancy, whereas female sex was inversely associated. ROC analysis identified optimal age thresholds of approximately 60\u00a0years for CSFs and 65\u00a0years for malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0154_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among asymptomatic patients with IDA, EGD demonstrated a substantially higher yield of CSFs and upper gastrointestinal malignancy than in asymptomatic controls, particularly among older individuals. These findings provide a large real-world benchmark for the isolated diagnostic yield of EGD and may inform future risk-stratified approaches to IDA evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2025-0154","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:56:22Z","timestamp":1784624182000},"source":"Crossref","is-referenced-by-count":1,"title":["The diagnostic yield of gastroscopy in the evaluation of asymptomatic patients with iron deficiency anemia"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0007-5902","authenticated-orcid":false,"given":"Ahmad","family":"Mahamid","sequence":"first","affiliation":[{"name":"Technion Israel Institute of Technology , Rappaport Faculty of Medicine , Haifa , Israel"},{"name":"Department of Surgery , Carmel Medical Center , Haifa , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randa Taher","family":"Natour","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology , Hillel Yaffe Medical Center , Hadera , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Mari","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology , Nazareth EMMS Hospital , Nazareth , Israel"},{"name":"Faculty of Medicine , Bar Ilan University , Bar Ilan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Khader","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology , Barzilai Medical Center , Ashkelon , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawi","family":"Hazzan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine , Bar Ilan University , Bar Ilan , Israel"},{"name":"Clalit Health Services, Northern Region , Afula , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3570-4545","authenticated-orcid":false,"given":"Oren","family":"Gal","sequence":"additional","affiliation":[{"name":"Technion Israel Institute of Technology , Rappaport Faculty of Medicine , Haifa , Israel"},{"name":"Department of Gastroenterology and Hepatology , Hillel Yaffe Medical Center , Hadera , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi Abu","family":"Baker","sequence":"additional","affiliation":[{"name":"Technion Israel Institute of Technology , Rappaport Faculty of Medicine , Haifa , Israel"},{"name":"Department of Gastroenterology and Hepatology , Hillel Yaffe Medical Center , Hadera , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026072108561691038_j_dx-2025-0154_ref_001","doi-asserted-by":"crossref","unstructured":"Safiri, S, Kolahi, AA, Noori, M, Nejadghaderi, SA, Karamzad, N, Bragazzi, NL, et al.. Burden of anemia and its underlying causes in 204 countries and territories, 1990\u20132019: results from the global burden of disease study 2019. J\u00a0Hematol Oncol 2021;14:185. https:\/\/doi.org\/10.1186\/s13045-021-01202-2.","DOI":"10.1186\/s13045-021-01202-2"},{"key":"2026072108561691038_j_dx-2025-0154_ref_002","doi-asserted-by":"crossref","unstructured":"Bouri, S, Martin, J. Investigation of iron deficiency anaemia. Clin Med (Lond) 2018;18:242\u20134. https:\/\/doi.org\/10.7861\/clinmedicine.18-3-242.","DOI":"10.7861\/clinmedicine.18-3-242"},{"key":"2026072108561691038_j_dx-2025-0154_ref_003","doi-asserted-by":"crossref","unstructured":"Barton, JC, Wiener, HH, Acton, RT, Adams, PC, Eckfeldt, JH, Gordeuk, VR, et al.. Prevalence of iron deficiency in 62,685 women of seven race\/ethnicity groups: the HEIRS study. PLoS One 2020;15:e0232125. https:\/\/doi.org\/10.1371\/journal.pone.0232125.","DOI":"10.1371\/journal.pone.0232125"},{"key":"2026072108561691038_j_dx-2025-0154_ref_004","doi-asserted-by":"crossref","unstructured":"Levi, M, Simonetti, M, Marconi, E, Brignoli, O, Cancian, M, Masotti, A, et al.. Gender differences in determinants of iron-deficiency anemia: a population-based study conducted in four European countries. Ann Hematol 2019;98:1573\u201382. https:\/\/doi.org\/10.1007\/s00277-019-03707-w.","DOI":"10.1007\/s00277-019-03707-w"},{"key":"2026072108561691038_j_dx-2025-0154_ref_005","doi-asserted-by":"crossref","unstructured":"Wang, M, Gao, H, Wang, J, Cao, C, Ying, X, Wei, Y, et al.. Global burden and inequality of iron deficiency: findings from the global burden of disease datasets 1990\u20132017. Nutr J 2022;21:16. https:\/\/doi.org\/10.1186\/s12937-022-00771-3.","DOI":"10.1186\/s12937-022-00771-3"},{"key":"2026072108561691038_j_dx-2025-0154_ref_006","doi-asserted-by":"crossref","unstructured":"Ko, CW, Siddique, SM, Patel, A, Harris, A, Sultan, S, Altayar, O, et al.. AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia. Gastroenterology 2020;159:1085\u201394. https:\/\/doi.org\/10.1053\/j.gastro.2020.06.046.","DOI":"10.1053\/j.gastro.2020.06.046"},{"key":"2026072108561691038_j_dx-2025-0154_ref_007","doi-asserted-by":"crossref","unstructured":"Camaschella, C. Iron-deficiency anemia. N\u00a0Engl J Med 2015;372:1832\u201343. https:\/\/doi.org\/10.1056\/nejmra1401038.","DOI":"10.1056\/NEJMra1401038"},{"key":"2026072108561691038_j_dx-2025-0154_ref_008","doi-asserted-by":"crossref","unstructured":"Lopez, A, Cacoub, P, Macdougall, IC, Peyrin-Biroulet, L. Iron deficiency anaemia. Lancet 2016;387:907\u201316. https:\/\/doi.org\/10.1016\/s0140-6736(15)60865-0.","DOI":"10.1016\/S0140-6736(15)60865-0"},{"key":"2026072108561691038_j_dx-2025-0154_ref_009","doi-asserted-by":"crossref","unstructured":"Yung, DE, Koulaouzidis, A, Douglas, S, Plevris, JN. Earlier use of capsule endoscopy in inpatients with melena or severe iron deficiency anemia reduces need for colonoscopy and shortens hospital stay. Endosc Int Open 2018;6:E1075\u201384. https:\/\/doi.org\/10.1055\/a-0640-2956.","DOI":"10.1055\/a-0640-2956"},{"key":"2026072108561691038_j_dx-2025-0154_ref_010","doi-asserted-by":"crossref","unstructured":"Carter, D, Levi, G, Tzur, D, Novis, B, Avidan, B. Prevalence and predictive factors for gastrointestinal pathology in young men evaluated for iron deficiency anemia. Dig Dis Sci 2013;58:1299\u2013305. https:\/\/doi.org\/10.1007\/s10620-012-2496-6.","DOI":"10.1007\/s10620-012-2496-6"},{"key":"2026072108561691038_j_dx-2025-0154_ref_011","doi-asserted-by":"crossref","unstructured":"Zubrikhina, GN, Blindar, VN, Matveeva, II. [The differential diagnostic possibilities in evaluation of iron-deficient condition under anemias]. Klin Lab Diagn 2016;61:144\u201350.","DOI":"10.17116\/terarkh201688461-67"},{"key":"2026072108561691038_j_dx-2025-0154_ref_012","doi-asserted-by":"crossref","unstructured":"Derman, RJ, Patted, A. Overview of iron deficiency and iron deficiency anemia in women and girls of reproductive age. Int J Gynaecol Obstet 2023;162:78\u201382. https:\/\/doi.org\/10.1002\/ijgo.14950.","DOI":"10.1002\/ijgo.14950"},{"key":"2026072108561691038_j_dx-2025-0154_ref_013","doi-asserted-by":"crossref","unstructured":"Mahamid, A, Abu-Zaydeh, O, Kazlow, E, Froylich, D, Sawaied, M, Goldberg, N, et al.. The effects of primary tumor location on survival after liver resection for colorectal liver metastasis in the mediterranean population. J\u00a0Clin Med 2023;12:5242. https:\/\/doi.org\/10.3390\/jcm12165242.","DOI":"10.3390\/jcm12165242"},{"key":"2026072108561691038_j_dx-2025-0154_ref_014","doi-asserted-by":"crossref","unstructured":"Almilaji, O, Webb, G, Maynard, A, Chapman, TP, Shine, BSF, Ellis, AJ, et al.. Broad external validation of a multivariable risk prediction model for gastrointestinal malignancy in iron deficiency anaemia. Diagn Progn Res 2021;5:23. https:\/\/doi.org\/10.1186\/s41512-021-00112-8.","DOI":"10.1186\/s41512-021-00112-8"},{"key":"2026072108561691038_j_dx-2025-0154_ref_015","doi-asserted-by":"crossref","unstructured":"De Franceschi, L, Iolascon, A, Taher, A, Cappellini, MD. Clinical management of iron deficiency anemia in adults: systematic review on advances in diagnosis and treatment. Eur J Intern Med 2017;42:16\u201323. https:\/\/doi.org\/10.1016\/j.ejim.2017.04.018.","DOI":"10.1016\/j.ejim.2017.04.018"},{"key":"2026072108561691038_j_dx-2025-0154_ref_016","doi-asserted-by":"crossref","unstructured":"Snook, J, Bhala, N, Beales, ILP, Cannings, D, Kightley, C, Logan, RP, et al.. British society of gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021;70:2030\u201351. https:\/\/doi.org\/10.1136\/gutjnl-2021-325210.","DOI":"10.1136\/gutjnl-2021-325210"},{"key":"2026072108561691038_j_dx-2025-0154_ref_017","doi-asserted-by":"crossref","unstructured":"Zhu, A, Kaneshiro, M, Kaunitz, JD. Evaluation and treatment of iron deficiency anemia: a gastroenterological perspective. Dig Dis Sci 2010;55:548\u201359. https:\/\/doi.org\/10.1007\/s10620-009-1108-6.","DOI":"10.1007\/s10620-009-1108-6"},{"key":"2026072108561691038_j_dx-2025-0154_ref_018","doi-asserted-by":"crossref","unstructured":"Demb, J, Liu, L, Murphy, CC, Doubeni, CA, Martinez, ME, Gupta, S. Time to endoscopy or colonoscopy among adults younger than 50\u00a0years with iron-deficiency anemia and\/or hematochezia in the VHA. JAMA Netw Open 2023;6:e2341516. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.41516.","DOI":"10.1001\/jamanetworkopen.2023.41516"},{"key":"2026072108561691038_j_dx-2025-0154_ref_019","doi-asserted-by":"crossref","unstructured":"Rockey, DC, Altayar, O, Falck-Ytter, Y, Kalmaz, D. AGA technical review on gastrointestinal evaluation of iron deficiency anemia. Gastroenterology 2020;159:1097\u2013119. https:\/\/doi.org\/10.1053\/j.gastro.2020.06.045.","DOI":"10.1053\/j.gastro.2020.06.045"},{"key":"2026072108561691038_j_dx-2025-0154_ref_020","doi-asserted-by":"crossref","unstructured":"G\u00f3mez, V, Bhalla, R, Heckman, MG, Florit, PTK, Diehl, NN, Rawal, B, et al.. Routine screening endoscopy before bariatric surgery: is it necessary? Bariatr Surg Pract Patient Care 2014;9:143\u20139. https:\/\/doi.org\/10.1089\/bari.2014.0024.","DOI":"10.1089\/bari.2014.0024"},{"key":"2026072108561691038_j_dx-2025-0154_ref_021","doi-asserted-by":"crossref","unstructured":"Ze, EY, Kim, BJ, Kang, H, Kim, JG. Abdominal visceral to subcutaneous adipose tissue ratio is associated with increased risk of erosive esophagitis. Dig Dis Sci 2017;62:1265\u201371. https:\/\/doi.org\/10.1007\/s10620-017-4467-4.","DOI":"10.1007\/s10620-017-4467-4"},{"key":"2026072108561691038_j_dx-2025-0154_ref_022","doi-asserted-by":"crossref","unstructured":"Gribsholt, SB, Farkas, DK, Jepsen, P, Richelsen, B, S\u00f8rensen, HT. Overweight\/obesity and gastrointestinal disease incidence in Denmark\u2013a cohort study. Eur J Endocrinol 2025;192:540\u20138. https:\/\/doi.org\/10.1093\/ejendo\/lvaf077.","DOI":"10.1093\/ejendo\/lvaf077"},{"key":"2026072108561691038_j_dx-2025-0154_ref_023","doi-asserted-by":"crossref","unstructured":"Gray, DM, Kushnir, V, Kalra, G, Rosenstock, A, Alsakka, MA, Patel, A, et al.. Cameron lesions in patients with hiatal hernias: prevalence, presentation, and treatment outcome. Dis Esophagus 2015;28:448\u201352. https:\/\/doi.org\/10.1111\/dote.12223.","DOI":"10.1111\/dote.12223"},{"key":"2026072108561691038_j_dx-2025-0154_ref_024","doi-asserted-by":"crossref","unstructured":"Mansour, D, Hofmann, A, Gemzell-Danielsson, K. A review of clinical guidelines on the management of iron deficiency and iron-deficiency anemia in women with heavy menstrual bleeding. Adv Ther 2021;38:201\u201325. https:\/\/doi.org\/10.1007\/s12325-020-01564-y.","DOI":"10.1007\/s12325-020-01564-y"},{"key":"2026072108561691038_j_dx-2025-0154_ref_025","doi-asserted-by":"crossref","unstructured":"Lee, HJ, Pak, H, Han, JJ, Chang, MH. Comprehensive analysis of iron deficiency anemia and its related disorders in premenopausal women based on a propensity score matching case control study using national health insurance service database in Korea. J\u00a0Kor Med Sci 2023;38:e299. https:\/\/doi.org\/10.3346\/jkms.2023.38.e299.","DOI":"10.3346\/jkms.2023.38.e299"},{"key":"2026072108561691038_j_dx-2025-0154_ref_026","doi-asserted-by":"crossref","unstructured":"Ilic, M, Ilic, I. Epidemiology of stomach cancer. World J Gastroenterol 2022;28:1187\u2013203. https:\/\/doi.org\/10.3748\/wjg.v28.i12.1187.","DOI":"10.3748\/wjg.v28.i12.1187"},{"key":"2026072108561691038_j_dx-2025-0154_ref_027","doi-asserted-by":"crossref","unstructured":"Abramowitz, BR, Saba, H, Aytaman, A, DiLeo, DA, Roland, BC. Diagnostic yield of bidirectional endoscopy for iron deficiency anemia in young patients. BMC Gastroenterol 2024;24:269. https:\/\/doi.org\/10.1186\/s12876-024-03372-y.","DOI":"10.1186\/s12876-024-03372-y"},{"key":"2026072108561691038_j_dx-2025-0154_ref_028","doi-asserted-by":"crossref","unstructured":"G\u00fczel, G, Ergen\u00e7, M. Diagnostic yield of bidirectional gastrointestinal system endoscopy for iron deficiency anemia. Ir J Med Sci 2025;194:1309\u201315. https:\/\/doi.org\/10.1007\/s11845-025-04008-0.","DOI":"10.1007\/s11845-025-04008-0"}],"container-title":["Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2025-0154\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2025-0154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:56:32Z","timestamp":1784624192000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2025-0154\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":28,"alternative-id":["10.1515\/dx-2025-0154"],"URL":"https:\/\/doi.org\/10.1515\/dx-2025-0154","relation":{},"ISSN":["2194-8011","2194-802X"],"issn-type":[{"value":"2194-8011","type":"print"},{"value":"2194-802X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]}}}