A retrospective study published in BMC Pediatrics reports that esophagogastroduodenoscopy (EGD) identified histologic abnormalities in 86.5% of children with refractory iron deficiency anemia who presented without gastrointestinal symptoms. The research, conducted at a tertiary pediatric gastroenterology center, examined 96 children who underwent diagnostic EGD between 2021 and 2025. The findings suggest that even in the absence of overt digestive complaints, endoscopic evaluation frequently uncovers underlying mucosal issues that may influence clinical management.

The study focused on a specific population of children with refractory iron deficiency anemia, defined as those who had failed oral iron therapy. The cohort consisted of 96 patients with a median age of 10.6 years and an interquartile range of 5.2 to 14.3 years. Slightly more than half of the participants were male, accounting for 54% of the group. The researchers aimed to address a gap in medical knowledge regarding the diagnostic yield of EGD in this asymptomatic subgroup, noting that current clinical practices vary significantly between different medical centers.

Methods involved a retrospective review of all diagnostic EGDs performed for iron deficiency anemia in children without gastrointestinal symptoms during the study period. The team used logistic regression to identify predictors of histologic abnormalities and assessed the concordance between macroscopic endoscopic findings and microscopic histologic results. This approach allowed the researchers to determine not only the frequency of abnormalities but also the reliability of visual endoscopic assessment compared to tissue sampling.

Results indicated that 83 of the 96 patients, or 86.5%, had histologic abnormalities identified during the procedure. Of these, 73 patients, representing 76.0% of the total cohort, had findings considered management-altering. Univariate analyses revealed that histologic abnormalities were more frequent among male patients, with a rate of 94.2% compared to 77.3% in females, a difference that was statistically significant with a p-value of 0.01. The prevalence was particularly high among children aged 10 years or younger, where 93.9% of males had abnormalities compared to 61.5% of females.

Children diagnosed with H. pylori gastritis were older on average, with a median age of 13.6 years, compared to 9.9 years for those with other types of gastritis. This age difference was statistically significant (p = 0.006). Additionally, children with H. pylori gastritis more frequently presented with nodular gastric mucosa, observed in 89.5% of cases versus 57.7% in other gastritis types, a difference with a p-value of less than 0.001.

The study also evaluated the agreement between macroscopic endoscopic appearance and microscopic histologic findings. The concordance was found to be moderate in both the duodenum and the stomach. In the duodenum, the kappa statistic was 0.58, with a 95% confidence interval of 0.38 to 0.78. In the stomach, the kappa statistic was 0.52, with a 95% confidence interval of 0.32 to 0.72. These results indicate that while endoscopic visualization provides useful information, it does not perfectly align with histologic diagnosis, supporting the practice of routine tissue sampling in this specific patient population.

The authors concluded that in this highly selected tertiary cohort, EGD frequently identified histologic abnormalities, many of which were management-altering. H. pylori gastritis emerged as the most frequent diagnosis. The limited agreement between endoscopic appearance and histology reinforces the importance of biopsy in children with refractory iron deficiency anemia who lack gastrointestinal symptoms. However, the authors noted that prospective studies are needed to confirm whether these targeted interventions lead to long-term hematologic recovery.

This research highlights the potential value of endoscopic evaluation in a clinical scenario where symptoms are absent but anemia persists despite standard treatment.

Subject of Research: Diagnostic yield of esophagogastroduodenoscopy in children with refractory iron deficiency anemia

Article Title: Endoscopic and histologic findings in children with refractory iron deficiency anemia without gastrointestinal symptoms

Article References: Vega, Y., Cohen, S., Anafy, A., Yerushalmy-Feler, A., Galai, T., Amir, A. Z., & Moran-Lev, H. (2026). Endoscopic and histologic findings in children with refractory iron deficiency anemia without gastrointestinal symptoms. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07977-y

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07977-y

Keywords: iron deficiency anemia, esophagogastroduodenoscopy, pediatric gastroenterology, histologic findings, Helicobacter pylori, refractory anemia, biopsy, clinical diagnosis, Endoscopic, histologic, findings, children