Anemia is considered a public health issue and is often caused by iron deficiency. Iron-deficiency anemia (IDA) often originates from blood loss from lesions in the gastrointestinal tract in men and postmenopausal women, and its prevalence among patients with gastrointestinal bleeding has been estimated to be 61%. However, few guidelines regarding the appropriate investigation of patients with IDA due to gastrointestinal bleeding have been published.
To review current evidence and guidelines concerning IDA management in gastrointestinal bleeding patients to develop recommendations for its diagnosis and therapy.
Five gastroenterology experts formed the Digestive Bleeding and Anemia Workgroup and conducted a systematic literature search in PubMed and professional association websites. MEDLINE (
From 494 Literature citations found during the initial literature search, 17 original articles, one meta-analysis, and 13 clinical practice guidelines were analyzed. Based on the published evidence and clinical experience, the workgroup developed the following ten recommendations for the management of IDA in patients with gastrointestinal bleeding: (1) Evaluation of hemoglobin and iron status; (2) Laboratory testing; (3) Target treatment population identification; (4) Indications for erythrocyte transfusion; (5) Treatment targets for erythrocyte transfusion; (6) Indications for intravenous iron; (7) Dosages; (8) Monitoring; (9) Indications for intravenous ferric carboxymaltose treatment; and (10) Treatment targets and monitoring of patients. The workgroup also proposed a summary algorithm for the diagnosis and treatment of IDA in patients with acute or chronic gastrointestinal bleeding, which should be implemented during the hospital stay and follow-up visits after patient discharge.
These recommendations may serve as a starting point for clinicians to better diagnose and treat IDA in patients with gastrointestinal bleeding, which ultimately may improve health outcomes in these patients.

Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review.

We carried out a systematic review and meta-analysis of epidemiologic studies on the association between occupational exposure to glyphosate and risk of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM).
We conducted a systematic search of the literature, and identified 18 relevant publications, from which we extracted results from seven non-overlapping studies of NHL and three of MM. We performed random-effects meta-analyses for ever-exposure to glyphosate, dose-response, and risk of specific NHL subtypes.
The meta-relative risk (RR) of NHL was 1.03 (95% confidence interval [CI] 0.86-1.21), that of MM was 1.04 (95% CI 0.67-1.41). The meta-RR of NHL for highest category of exposure was 1.49 (95% CI 0.37-2.61; 3 studies). The meta-RR for diffuse large B-cell lymphoma (DLBCL) was 1.31 (95% CI 0.93-1.75); that for follicular lymphoma was 0.82 (95% CI 0.93-1.70), and that for chronic lymphocytic leukemia was 0.85 (95% CI 0.20-1.49). There was indication of publication bias for studies on NHL.
Our meta-analysis provided no overall evidence of an increased risk for both NHL and MM in subjects occupationally exposed to glyphosate. In secondary analyses we detected a small increase in risk for the category with highest level of exposure as well as for DLBCL. The evidence of publication bias suggests caution in the interpretation of the results.
Sono state condotte una revisione sistematica e una meta-analisi degli studi epidemiologici sull’associazione tra esposizione professionale a glifosato e rischio di linfoma non Hodgkin (NHL) e mieloma multiplo (MM).
È stata effettuata una ricerca sistematica della letteratura che ha portato all’identificazione di 18 pubblicazioni rilevanti, da cui sono stati estratti i risultati di sette studi indipendenti sul NHL e tre sul MM. È stata effettuata una meta-analisi con modello ad effetti casuali per esposizione a glifosato, inclusi i risultati su dose-risposta e su sottotipi specifici di NHL.
Il rischio relativo (RR) della meta-analisi per NHL è risultato pari a 1,03 (intervallo di confidenza al 95% [CI] 0,86-1,21), e quello per MM pari a 1,04 (IC al 95% 0,67-1,41). Il RR per NHL nella più alta categoria di esposizione è risultato pari a 1,49 (IC 95% 0,37-2,61; 3 studi). Il RR per linfoma diffuso a grandi cellule B (DLBCL) è risultato pari a 1,31 (IC 95% 0,93-1,75); quello per il linfoma follicolare pari a 0,82 (IC 95% 0,93-1,70) e quello per la leucemia linfatica cronica pari a 0,85 (IC 95% 0,20-1,49). Si è riscontrata un’indicazione di bias di pubblicazione negli studi su NHL.
In generale, questa meta-analisi non ha fornito la prova di un aumento del rischio sia per NHL che per MM in soggetti esposti professionalmente a glifosato. In analisi secondarie è stato evidenziato un leggero aumento del rischio per la categoria con il più alto livello di esposizione e per DLBCL. L’evidenza di un bias di pubblicazione suggerisce cautela nell’interpretazione dei risultati.

Exposure to glyphosate and risk of non-Hodgkin lymphoma and multiple myeloma: an updated meta-analysis.

Iron deficiency anemia (IDA) is one of the leading causes of anemia, globally. Oral vitamin C enhances iron absorption and is commonly prescribed with iron for anemia patients. Considering the lack of evidence to support this practice, we conducted this systematic review and meta-analysis to determine the treatment efficacy of experimental studies where oral vitamin C or ascorbate was given as co-intervention with iron compared to providing only iron among participants with anemia of all ages.
A comprehensive strategy was used to search literature from PubMed, Cochrane and Google Scholar. Experimental studies conducted among participants with lab-confirmed anemia at baseline, with "oral ascorbic acid or vitamin C given as co-intervention with iron" as intervention and "only oral iron" as the comparator, and reported the outcomes hemoglobin or ferritin, were selected. Random-effects model was used to estimate standardized mean differences or odds ratio of outcomes, and sensitivity analyses were done. Sub-group and meta-regression analyses were conducted to evaluate the reasons for heterogeneity (PROSPERO number: CRD42022306612).
Of the total nine studies included in the review, seven studies with 905 participants were included for meta-analysis. The pooled estimate for standardized mean difference (SMD) of hemoglobin (g/dL) and Serum Ferritin (mcg/L) for intervention-type ferrous ascorbate were 0.44 (95% C.I.: -0.30, 1.26) and 0.03 (95% C.I.: -0.68, 0.73) respectively, and were not statistically significant. The pooled estimate for SMD of hemoglobin (g/dL) and Serum Ferritin (mcg/L) for intervention type 'oral iron and vitamin C' was 0.11 (95% C.I.: -0.05, 0.28) and -0.90 (95% C.I.: -1.09, -0.72) respectively, and were not statistically significant.
The SMD of hemoglobin or serum ferritin between the intervention group were not significantly favouring the intervention when the intervention group was ferrous ascorbate or oral iron and vitamin C, and the methodological quality of evidence of these effect measures was very low. This necessitates studying the treatment efficacy of oral vitamin C or ascorbate when given with oral iron for participants with anemia in future clinical trials.

Treatment efficacy of vitamin C or ascorbate given as co-intervention with iron for anemia - A systematic review and meta-analysis of experimental studies.

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