Coded Gastrointestinal Diagnoses in Women Aged 18–44 Years with Iron Deficiency Anemia Without Selected Coded Alarm Features Who Underwent Same-Day Bidirectional Endoscopy: A Multicenter U.S. Electronic Health Record Study

The role of bidirectional endoscopy in younger women with iron deficiency anemia (IDA) and no alarm features remains uncertain. To describe gastrointestinal (GI) codes recorded through 3 months after same-day bidirectional endoscopy in women aged 18–44 years with biochemically supported IDA and without selected coded alarm features. We conducted a retrospective descriptive TriNetX study. The first colonoscopy defined index; esophagogastroduodenoscopy was required the same day. An IDA code, hemoglobin ≤12 g/dL, and ferritin ≤45 ng/mL were required within 3 months on or before index. Outcomes were codes recorded from index through 3 months afterward. A sensitivity analysis excluded prior colorectal malignancy and inflammatory bowel disease (IBD) codes. The cohort included 769 women from 57 organizations (mean age, 37 [SD, 6] years); the condition-specific denominator was 768. Common upper-GI codes were gastritis/duodenitis (343/768, 44.7%), hiatal hernia (84/768, 10.9%), Helicobacter pylori (78/768, 10.2%), and gastric/duodenal ulcer (48/768, 6.3%); no upper-GI malignancy code was recorded. Lower-GI codes included hemorrhoids (246/768, 32.0%), D12-coded benign colorectal/anal neoplasm (93/768, 12.1%), and IBD (67/768, 8.7%). The colorectal malignancy code count was privacy suppressed (1–10/768; ≤1.3%). After excluding prior IBD codes, 13/710 (1.8%) had an IBD code recorded. These coded diagnoses cannot be assumed to represent newly detected lesions or causes of IDA. Without a non-endoscoped comparison group, the study cannot establish the benefit of routine or selective endoscopy.