Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa
Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID...
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South African Medical Association
2024-02-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/711 |
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| author | W M Simmonds Y Awuku C Barrett M Brand K Davidson D Epstein E Fredericks S Gabriel S Grobler C Gounden L Katsidzira V J Louw V Naidoo C Noel E Ogutu N Ramonate N Seabi M Setshedi J Van Zyl G Watermeyer C Kassianides |
| author_facet | W M Simmonds Y Awuku C Barrett M Brand K Davidson D Epstein E Fredericks S Gabriel S Grobler C Gounden L Katsidzira V J Louw V Naidoo C Noel E Ogutu N Ramonate N Seabi M Setshedi J Van Zyl G Watermeyer C Kassianides |
| author_sort | W M Simmonds |
| collection | DOAJ |
| description |
Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products.
Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group.
Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
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| format | Article |
| id | doaj-art-1e515de734ac45fb954773698bd78e01 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-1e515de734ac45fb954773698bd78e012025-02-10T12:26:29ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-02-011141b10.7196/SAMJ.2024.v114i1b.711Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan AfricaW M Simmonds0Y Awuku1C Barrett2M Brand3K Davidson4D Epstein5E Fredericks6S Gabriel7S Grobler8C Gounden9L Katsidzira10V J Louw11V Naidoo12C Noel13E Ogutu14N Ramonate15N Seabi16M Setshedi17J Van Zyl18G Watermeyer19C Kassianides20Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South AfricaDepartment of Medicine, University of Health and Allied Sciences, Ho, GhanaSchool of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South AfricaDepartment of General Surgery, School of Medicine, University of Pretoria, South AfricaPrivate practice, IBD nurse specialist, Cape Town, South AfricaDivision of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Medicine, Stellenbosch University, South AfricaGastroenterology Unit, Tygerberg Hospital and Stellenbosch University, South Africaniversitas Netcare Private Hospital, Bloemfontein, South AfricaDepartment of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South AfricaInternal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, ZimbabweDivision of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South AfricaDivision of Gastrointestinal Surgery, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South AfricaDepartment of Internal Medicine, University of Nairobi and Kenyatta National Hospital, KenyaGastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South AfricaGastroenterology Division, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South AfricaDivision of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Internal Medicine, Faculty of Health Sciences, University of the Free State and Netcare Universitas Private Hospital, Bloemfontein, South AfricaDivision of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Medicine, Faculty of Health Sciences, University of Cape Town and Morningside Mediclinic, Johannesburg, South Africa Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia. https://samajournals.co.za/index.php/samj/article/view/711GuidelinesGastrointestinalEvaluationManagementIron DeficiencyIron Deficiency Anaemia |
| spellingShingle | W M Simmonds Y Awuku C Barrett M Brand K Davidson D Epstein E Fredericks S Gabriel S Grobler C Gounden L Katsidzira V J Louw V Naidoo C Noel E Ogutu N Ramonate N Seabi M Setshedi J Van Zyl G Watermeyer C Kassianides Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa South African Medical Journal Guidelines Gastrointestinal Evaluation Management Iron Deficiency Iron Deficiency Anaemia |
| title | Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa |
| title_full | Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa |
| title_fullStr | Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa |
| title_full_unstemmed | Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa |
| title_short | Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa |
| title_sort | guidance for the gastrointestinal evaluation and management of iron deficiency in sub saharan africa |
| topic | Guidelines Gastrointestinal Evaluation Management Iron Deficiency Iron Deficiency Anaemia |
| url | https://samajournals.co.za/index.php/samj/article/view/711 |
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