Falling Prevalence of GI Malignancy in Adults With Iron Deficiency Anaemia – IDIOM V: Endoscopy | 2026

Introduction

Iron deficiency anaemia (IDA) has long been considered an important red flag for underlying gastrointestinal (GI) malignancy. However, with evolving referral patterns, widespread endoscopic access, and prior imaging, the true contemporary cancer yield in IDA requires reassessment.

Summary

In this audit of 1253 consecutive adults referred to a hospital IDA service (2022–2023), 934 underwent full GI investigation. The prevalence of GI cancer was 5.6%, confirming a continued decline compared with historical figures. Two variables showed strong negative associations with malignancy: prior colonic imaging within 5 years and long-term proton pump inhibitor (PPI) exposure. Incorporating PPI status into the existing IDIOM risk score improved predictive discrimination (c-statistic 0.84 vs 0.77). These findings support a shift toward refined risk stratification rather than universal invasive investigation, with prospective validation needed before practice change.