Celiac disease in patients with iron deficiency anemia - Tips from Other Journals

Author: Linz Audain
Date: Feb 15, 1997

Celiac disease is characterized in part by villous atrophy on small bowel biopsy. Patients with celiac disease sometimes present with iron deficiency anemia. Ackerman and associates investigated the effectiveness of small bowel biopsy in diagnosing celiac disease in the routine evaluation of patients with iron deficiency anemia.

Ninety-three patients who had been diagnosed with iron deficiency anemia and 69 patients who did not have iron deficiency anemia were prospectively studied. Of the 69 patients in the control group, 23 had steatorrhea, 37 had idopathic diarrhea of more than three months' duration and nine had small bowel biopsy performed for miscellaneous reasons such as unexplained weight loss, abdominal pain or short stature. Esophagogastroduodenoscopy was performed in study participants, and three biopsies of the duodenum were obtained from each patient. Biopsies were obtained from patients with preexisting duodenal lesions at sites at least 5 cm distal to the lesions. Small bowel biopsy was performed for each patient, even when the source of bleeding was determined by previous examination.

Of the 93 patients with iron deficency anemia, 11 were found to have celiac disease on biopsy of the small bowel. Two of the 69 patients without iron deficiency anemia had biopsy findings consistent with the diagnosis of celiac disease. Both patients were from the control group with steatorrhea.

The authors note that, when compared with patients with normal biopsy findings, patients with celiac disease were younger and had significantly lower hemoglobin levels, more severe and longstanding anemia, a greater incidence of other gastrointestinal lesions (e.g., colitis), a higher prevalence of diarrhea both currently as well as in the past, a greater incidence of osteopenia, a greater incidence of low albumin and cholesterol levels, and a greater likelihood of a family history of celiac disease.

The authors conclude that celiac disease should be part of the differential diagnosis in evaluating patients with iron deficiency anemia. They determined that occult celiac disease is not an uncommon finding in adult Israeli patients presenting with iron deficiency anemia and recommend using the characteristics listed in the preceding paragraph to select patients with iron deficiency anemia in whom small bowel biospy should be performed.

Ackerman Z, et al. Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol 1996;91:2099-102.

EDITOR'S NOTE: Should physicians consider celiac disease in patients with iron deficiency anemia who have an obvious source of gastrointestinal bleeding? In some cases, the answer is yes. Fortunately, the authors provide some criteria and guidelines to determine which patients to consider for further investigation.

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