Indian Journal of Gastroenterology

, Volume 33, Issue 2, pp 114–118 | Cite as

Prevalence of celiac disease in nutritional anemia at a tertiary care center

  • Amit Kavimandan
  • Meenakshi Sharma
  • Anil K. Verma
  • Prasenjit Das
  • Prabhash Mishra
  • Sanjeev Sinha
  • Anant Mohan
  • V. Sreenivas
  • Siddhartha Datta Gupta
  • Govind K. Makharia
Original Article

Abstract

Background

While anemia occurs in 80 % to 90 % of patients with celiac disease (CD), it may be the sole manifestation of CD. The prevalence of CD in Indian patients with nutritional anemia is not known.

Patients and Methods

Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy.

Results

Ninety-six patients [mean ± SD age 32.1 ± 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean ± SD duration of diarrhea in them was 9.7 ± 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B12 deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration.

Conclusions

CD screening should be included in the work up of otherwise unexplained nutritional anemia.

Keywords

Enteropathy Iron deficiency Megaloblastic anemia 

References

  1. 1.
    Rewers M. Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology. 2005;128 4 Suppl 1:S47–51.PubMedCrossRefGoogle Scholar
  2. 2.
    Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol. 2011;26:894–900.PubMedCrossRefGoogle Scholar
  3. 3.
    Murray JA. Celiac disease in patients with an affected member, type 1 diabetes, iron-deficiency, or osteoporosis? Gastroenterology. 2005;128 Suppl 1:S52–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Makharia GK, Baba CS, Khadgawat R, et al. Celiac disease: variations of presentations in adults. Indian J Gastroenterol. 2007;26:162–6.PubMedGoogle Scholar
  5. 5.
    Agarwal N, Puri AS, Grover R. Non-diarrheal celiac disease: a report of 31 cases from northern India. Indian J Gastroenterol. 2007;26:122–6.PubMedGoogle Scholar
  6. 6.
    Corazza GR, Valentini RA, Andreani ML, et al. Subclinical celiac disease is a frequent cause of iron deficiency anemia. Scand J Gastroenterol. 1995;30:153–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Mandal AK, Mehdi I, Munshi SK, Lo TC. Value of routine duodenal biopsy in diagnosing celiac disease in patients with iron deficiency anemia. Postgrad Med J. 2004;80:475–7.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Unsworth DJ, Lock RJ, Harvey RF. Improving the diagnosis of celiac disease in anemic women. Br J Haematol. 2000;111:898–901.PubMedGoogle Scholar
  9. 9.
    Haapalahti M, Kulmala P, Karttunen TJ, et al. Nutritional status in adolescents and young adults with screen-detected celiac disease. J Pediat Gastroenterol Nutr. 2005;40:566–70.CrossRefGoogle Scholar
  10. 10.
    Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998;92:1191–8.PubMedGoogle Scholar
  11. 11.
    Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol. 2001;96:745–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Dickey W. Low serum vitamin B12 is common in celiac disease and is not due to autoimmune gastritis. Eur J Gastroenterol Hepatol. 2002;14:425–7.PubMedCrossRefGoogle Scholar
  13. 13.
    World Health Organization. Nutritional anemia: report of a WHO scientific group. Technical report series no. 405. Geneva: WHO; 1968.Google Scholar
  14. 14.
    Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillières Clin Gastroenterol. 1995;9:273–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Ransford RA, Hayes M, Palmer M, Hall MJ. A controlled, prospective screening study of celiac disease presenting as iron deficiency anemia. J Clin Gastroenterol. 2002;35:228–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Varma S, Malhotra P, Kochhar R, et al. Celiac disease presenting as iron-deficiency anemia in northern India. Indian J Gastroenterol. 2001;20:234–6.PubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2013

Authors and Affiliations

  • Amit Kavimandan
    • 1
  • Meenakshi Sharma
    • 1
  • Anil K. Verma
    • 1
  • Prasenjit Das
    • 2
  • Prabhash Mishra
    • 3
  • Sanjeev Sinha
    • 4
  • Anant Mohan
    • 4
  • V. Sreenivas
    • 5
  • Siddhartha Datta Gupta
    • 2
  • Govind K. Makharia
    • 1
  1. 1.Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of HematologyAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Department of MedicineAll India Institute of Medical SciencesNew DelhiIndia
  5. 5.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations