Is Routine Duodenal Biopsy Necessary for the Detection of Celiac Disease in Patients Presenting with Iron Deficiency Anemia?

Mohammad Hassan Emami, Somayeh Karimi, Soheila Kouhestani


Backgrounds: Iron deficiency anemia (IDA) is one of the well
recognized presentations of celiac disease (CD). According to the
lack of data from our population in this regard, we determined the prevalence of CD in patients presenting with IDA to see if it is worthwhile to do a precise screening for CD in such patients.
Methods: This cross-sectional study was conducted on patients
referred with IDA to Poursina Hakim Gastroenterology Clinic, Isfahan (IRAN). All included patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Also, patients were evaluated for IgA anti-tissue transglutaminase (t-TG) antibody with enzyme-linked immunosorbent assay (ELISA) technique. CD was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten free diet (GFD).
Results: During the study, 130 patients with the mean age of
35.5±13.7 (67.7% female [20.4% post-menopausal]) were undergone seropathological studies. According to  histopathological study and a clinical response to GFD, 13 patients (10%) were ultimately diagnosed with CD. Nine patients (6.9%) were seropositive, from which, five patients (3.8%) were ultimately diagnosed as CD cases. IgA anti-tTG became negative in all of these patients after six months of GFD.
Conclusion: CD should be considered in any adult patient
presenting with unexplained IDA, even if not accompanied with
gastrointestinal symptoms. Routine duodenal biopsy performed
during diagnostic upper gastrointestinal endoscopy is worthwhile
in order to investigate for CD as an underlying cause of IDA in
adult patients.
Keywords: Celiac disease, diagnosis, iron deficiency anemia

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