GiT Updates and More

✳️ Iron Deficiency Anemia ; Epidemiology, Screening, and Prevention Diagnosis and Evaluation Treatment Practice Improvement. ( PDF 👇 )

Annals of Internal Medicine 13 jan 2026

✳️ Iron deficiency anemia (IDA) is the type of anemia typically seen in chronic blood loss from gastric ulcers, duodenal ulcers, or colonic polyps.This anemia is characteristically microcytic and hypochromic due to depleted iron stores from ongoing blood loss. ▶️ Chronic gastrointestinal bleeding is the most important cause of iron deficiency in men and postmenopausal women. Each mL of blood contains 0.4–0.5 mg of iron, so even occult bleeding from these lesions progressively depletes iron stores. ▶️ In patients with IDA referred for endoscopy, potentially bleeding lesions are identified in 62% of cases, including peptic ulceration in 19%. ▶️ Common upper gastrointestinal causes include erosions or ulcers related to aspirin and NSAIDs, as well as peptic ulcer disease, while lower gastrointestinal causes include colorectal cancer, angiodysplasia, and colonic polyps. ▶️ Recurrent blood loss accounts for up to 94% of IDA cases in adults. The diagnosis is established by a serum ferritin level less than 45 ng/mL (or less than 100 ng/mL in the presence of inflammation) along with anemia. ▶️ In men and postmenopausal women presenting with IDA, bidirectional endoscopy should be performed to identify the bleeding source.

✳️ Practical guidelines on endoscopic treatment for Crohn's disease strictures: ▶️ EBD is efficacious and safe for primary or anastomotic strictures <4-5 cm in length. ▶️ EBD is more efficacious and safer for a small number of strictures (n<4) in close proximity to each other than for multiple stricutres (n>4). ▶️ EBD should be avoided for strictures with deep ulcerations. ▶️ EBD might be less effective for strictures with prestenotic luminal dilation. ▶️ EBD is not recommended for patients with concurrent fistulae or abscesses adjacent to the intestinal strictures. ▶️ Avoid injection of steroids or anti-TNF. ▶️ Endoscopic electroincision can be done in patients with EBD-refractory strictures in centres with the necessary technical capabilities. ▶️ Electroincision can be particularly useful for anorectal strictures in patients with Crohn's disease. ▶️ Electroincisions can be made using various knives with an endoscopic retrograde cholangiopancreatography power setting (ie, Endocut mode). ▶️ Fully covered removable metal stents can be used for refractory strictures in selected patients if EBD and endoscopic electroincision are unsuccessful.

2025 Focused Update of the Seoul Consensus on Gastroesophageal Reflux Disease: Evidence-based Recommendations on Acid Suppressive Therapy. PDF 👇

Preventive Care in Inflammatory Bowel Disease

✳️ NSAIDs use in IBD patients ▶️ Current ACG guidelines recommend viewing routine NSAID use with caution in Crohn's disease patients, noting they may exacerbate disease activity. ▶️ British Society of Gastroenterology guidelines (BSG) indicate short-term use is relatively safe when IBD is well-controlled, with approximately 20% relapse risk, and that selective COX-2 inhibitors show no difference from placebo in meta-analyses. ▶️ NSAIDs should be avoided in acute severe ulcerative colitis, as they have been associated with IBD-related hospitalizations and disease relapses. ▶️ When pain management is needed, consider acetaminophen as an alternative, though one study found it was also associated with active Crohn's disease (possibly as a marker of subclinical disease activity rather than causation). ▶️ If NSAIDs are necessary, consider selective COX-2 inhibitors or low-dose aspirin as potentially safer alternatives for short-term use in patients with well-controlled disease.