I just found out through blood tests that I have anemia -- my hemoglobin count is down to eight. My doctor wants to check out my digestive tract. What specifically are they looking for? I haven't had any kind of stomach pain, other than severe bloating whenever I eat.

A.F.

People with anemia, which is a lower-than-normal amount of red blood cells, are often referred to a gastroenterologist because one reason for anemia is a slow loss of blood into the digestive tract. There are many possible causes for bleeding in the digestive tract, including ulcers, abnormal blood vessels in the intestine and, most importantly, cancer. Any digestive tract cancer, from the stomach to the colon, can slowly bleed and lead to anemia. Often microscopic amounts of blood are found in the stool on testing and further support a diagnosis of bleeding from the digestive tract.

The specific endoscopic test done to evaluate anemia depends on the patient's symptoms, as well as the presence of blood in the stool. If someone complains of upper abdominal pain, an upper endoscopy is done. If the complaint includes constipation or lower abdominal pain, a colonoscopy is done. If blood is found in the stool, a colonoscopy is in order. If the anemia is one that is due to low iron in the blood, then both an upper endoscopy and a colonoscopy will probably be done because it could involve bleeding anywhere in the digestive tract.

Your complaint of bloating -- an upper-intestinal complaint -- will likely lead your gastroenterologist to perform an upper endoscopy. Your hemoglobin is significantly reduced to 8 (normal is 13-15), and if it is because of iron loss, a colonoscopy should be done as well. It is important to have these tests done to ensure that a possible cancer is not missed.