Is an endoscopy advisable for a patient with no GI symptoms?

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Posted on Wed, 17 Jun 2015 in Digestion and Bowels
Question: Hello,

I have had slight anemia for as long as I can recall I have had a slight amount of anemia, hypochromic, microcytic, anemia despite taking 325 mg ferrous sulfate for the past year. Recently, my doctor also did tests to check my serum vitamin levels and I know vitamin D was very low and another vitamin too. He says that I might have celiac and wants to do endoscopy, colonoscopy, and other yucky things. But I'm confused because I don't and never have had any kind of gastrointestinal symptoms. No pain, no diarrhea, no constipation, nothing? Could I have celiac without any overt gastrointestinal symptoms?
doctor
Answered by Dr. Amarnath 25 minutes later
Brief Answer:
I don't see a need for endoscopy and colonoscopy yet

Detailed Answer:
welcome to health care magic,
If you have only hypochromic microcytic aneamia, continue iron, ferrous sulphate medications,
1. have a healthy diet rich in vitamins and minerals
2. increase your intake of iron rich foods like spinach, dates,etc. everyday
3. dont panic of having black coloured stools when you are having iron suppliments in your diet.
4. without any gastrointestinal symptoms, there will not be any need to do colonoscopy or endoscopy to you. Unless you have missed on any relevant fact, I wouldn't agree for colonoscopy or endoscopy.
5. have adequate sun exposture if possible for vitamin D(sun bath etc) and have vitamin suppliments if needed.
6. review with your blood results and other investigations if taken already with detailed history for better interpretation of your current condition.
hope this explains in detail.
with regards
Dr.Amarnath
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Amarnath 21 minutes later
I have been given these instructions before. Time in the sun--I ride my bike at least 30 minutes a day. Spinach in all salads/sandwiches. More vitamin D fortified milk. Iron supplements. Vitamin supplements. My doctor says my body is not able to absorb these for an unknown reason that we have to figure out. He says best place to start is gastrointestinal tract. So you would just do nothing unless I had some obvious gastro symptoms, and ignore the deficiencies until they become a problem of some kind?
doctor
Answered by Dr. Amarnath 25 minutes later
Brief Answer:
Need for further evaluation...

Detailed Answer:
As I understand now, you have microcytic hypochromic anemia despite taking oral iron supplements along with vitamin d deficiency. The causes for microcytic hypochromic anemia include nutritional ( iron deficiency anemia) and anemia of chronic diseases. I presume you have no chronic iron deficiency. In this context (as you are taking ferrous sulfate for almost a year and you don't see any increase in your lab values) I realize your doctor is planning further investigations to check for malaborption including celiac disease.

Though you don't have any symptoms of celiac, your doctor seems right to look for reasons of malabsorption. If you aren't prepared for this test right away, please discuss about adding vitamin c supplement along with iron supplement and recheck reticulocyte count after 2-3 months. Continue vitamin D fortified supplement,

In a nutshell, considering the fact you have nutritional deficiency and supplements didn't help in correcting deficiency, it is appropriate to get endoscopy and biopsy.

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Amarnath

General & Family Physician

Practicing since :2002

Answered : 463 Questions

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