LOS ANGELES — In patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.
In particular, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, the results from a study of Veterans Affairs patients showed.
“Not only do [blacks and Hispanics] have more advanced lesions, but their lesions also tend to be proximal. Instead of doing a flexible sigmoidoscopy every 3–5 years, we might [need to do] only colonoscopy, to [get to] the proximal colon,” said Dr. Chander, a recent New York University graduate.
She and her colleagues evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of those, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups. Iron deficiency was defined as a transferrin saturation of less than 15% and a ferritin level of less than 20 μg/L. Anemia was defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women. All of the patients had a same-day esophagogastroduodenoscopy and colonoscopy.
The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of those from other ethnic groups. About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% in other ethnic groups. In the lower GI tract, 32% of whites had clinically important lesions, compared with 48% of blacks, 43% of Hispanics, and 42% in other ethnic groups. Upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% in other ethnic groups.
They also noted that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and those from other ethnic groups (8%).
Of those who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than it was in whites (63%) and patients from other ethnic groups (75%).
“Most likely Hispanics are seeking less health care than other groups,” said Dr. Chander, adding that diet and other lifestyle choices may also play a role.