LOS ANGELES — Among 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.
Specifically, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, results from a study of Veterans Affairs patients showed.
“We might have to be more aggressive in terms of colorectal screenings in blacks and Hispanics,” Dr. Chander, a recent graduate of New York University, said in an interview. “Not only do they have more advanced lesions, but their lesions also tend to be proximal. So instead of doing a flexible sigmoidoscopy every 3–5 years in blacks and Hispanics, we might have to advocate that we should only do colonoscopy, so we can get to the proximal colon as well.”
She and her associates 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 the 1,081 patients, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups.
Iron deficiency was defined as a transferrin saturation below 15% and a ferritin level below 20 μg/L. Anemia was defined as a hemoglobin level below 13 g/dL in men and below 12 g/dL in women. All 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 patients 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% of patients from other ethnic groups.
In addition, 32% of whites had clinically important lesions in the lower GI tract, compared with 48% of blacks, 43% of Hispanics, and 42% of patients from other ethnic groups.
Both upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% of patients from other ethnic groups.
In addition, Dr. Chander and her associates observed 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 patients from other ethnic groups (8%).
Of the patients who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than in whites (63%) and in patients from other ethnic groups (75%).
“Most likely Hispanics are seeking less health care than the other groups,” Dr. Chander hypothesized. “But on top of that, I'm sure that diet and other lifestyle choices have probably played a role.”
However, she noted certain limitations of the study, including the fact that it was a single-center study in which most of the subjects were older men. “We can't make generalizations about women in this study, nor can we about a younger population,” she said.