Anémies d'origine digestive

Abstract

Anaemia induced by digestive diseases refers to those types of anaemia due to iron, cobalamin, or folate deficiencies. The body contents of iron, cobalamin, folate depends on the digestive tract integrity. Inflammatory anaemias (or anaemias of chronic diseases), aregenerative anaemias in relation with digestive cancer bone marrow metastasis, rare haemolytic anaemias observed in the course of digestive cancers are described elsewhere. Iron deficiency is diagnosed in case of a hyposideremia associated either with transferrin elevation or with hypoferritinemia: in case of combined inflammatory syndrome and iron deficiency, a frequent situation in gastroenterology, the elevation of transferrin receptor 1 in the serum is a precious argument. Diagnosis of cobalamin and folate deficiencies need the assessment of vitamin B₁₂ serum level, serum and erythrocytes folate levels, and eventually urinary homocysteinuria and methyl-malonic aciduria appreciations. The etiologic diagnosis of digestive diseases anaemia is suggested in over half of the cases after anamnesis and clinical examination. Investigating the cause of an occult bleeding has been improved by the new technique of the intestinal wireless video-capsule. However, complementary investigations have been impoverished in case of cobalamin deficiency due to the difficulty of obtaining Schilling test (with cristallin or protein-bound cobalamin) with and without Intrinsic Factor concomitant administration. Therefore, in the absence of serum Intrinsic Factor antibodies and in the absence of any evident intestinal malabsorption syndrome, it is now difficult to distinguish pernicious anaemia from the frequent alimentary protein-bound malabsorption syndrome seen in cases of simple achlorhydria with a still good Intrinsic Factor hourly output. This situation will conduct to reintroduce gastric intubation in the vitamin B₁₂ deficiencies routine investigations. The treatment of digestive diseases anaemia is substitutive. The most important treatment is the treatment of the cause since anaemia is a symptom, not a disease.