Prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin in Kashmir (India)
- 162 Downloads
The purpose of this study was to evaluate the prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin.
One hundred and sixty-one consecutive patients with iron-deficiency anemia of obscure origin were evaluated. Tissue transglutaminase antibodies levels were done and duodenal biopsies were scored according to Marsh classification. Diagnosis was based on positive IgA anti-tissue transglutaminase antibodies and abnormal histopathology. Gluten-free diet (GFD) was adviced for celiac disease patients. One hundred and sixty healthy blood donors were tested for IgA anti-tissue transglutaminase antibodies, and positive controls were subjected to endoscopic duodenal biopsy.
Tissue transglutaminase antibodies were positive in 13 (8 %) patients with iron-deficiency anemia of obscure origin and 4 (2.5 %) in control group (p = 0.026) (odds ratio 3.42; 95 % confidence interval [CI]: 1.092–10.743). All 13 patients (8 %) and 2 out of 4 positive controls (1.25 %) had histopathology findings of celiac disease (p = 0.004). Duodenal biopsy showed Marsh grade 1 in 4, grade 2 in 4 (30.77 %), 3a in 1 (7.70 %), 3b in 2 (15.38 %), and 3c in 2 (15.38 %) patients. A statistically significant correlation was found between lower hemoglobin concentration and higher Marsh grading (Spearman’s rho = −0.946, p = 0.001). Celiac disease patients adhered to GFD and after 6 months mean (SD) hemoglobin levels increased from 7.42 ± 0.96 to 10.47 ± 0.80 g/dL (p- < 0.001).
Patients with iron-deficiency anemia of obscure origin had increased prevalence of celiac disease. Gluten-free diet improved anemia in celiac disease patients irrespective of grade of duodenal involvement.
KeywordsCeliac disease Duodenal biopsy Gluten-free diet Iron-deficiency anemia of obscure origin Tissue transglutaminase antibodies
Conflict of interest
GJ, SNL, AS, BAK, GNY, AS, JSS, MAK, and SAZ all declare that they have no conflict of interest.
The study was performed in a manner to conform with the Helsinki Declaration of 1975 as revised on 2008 concerning Human and Animal Rights and the authors followed the policy concerning informed consent as shown on Springer. Com
- 15.Unsworth DJ, Lock RJ, Harvey RF. Improving the diagnosis of coeliac disease in anaemic women. Br J Haematol. 2000;11:898–901.Google Scholar
- 17.Walia BNS, Sidhu JK, Tandon BN, Ghai OP, Bhargava S. Coeliac disease in North Indian children. Br Med J. 1966;2 Suppl:1233–4.Google Scholar
- 23.Yaccha SK, Poddar U. Celiac disease in India. Indian J Gastroenterol. 2007;26:230–7.Google Scholar
- 27.McDonald JH. Hand book for biological statistics. 3rd ed. Baltimore, Maryland: Sparky House Publishing; 2014.Google Scholar
- 30.Negi RC, Sharma B, Thakur S, Gupta D, Sharma A, Kaushal SS. Clinical profile of coeliac disease in Himachal Pradesh. JIACM. 2013;14:222–4.Google Scholar
- 36.Brar P, Kwon GY, Egbuna II, et al. Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. Dig Liver Dis. 2007;39:26–9.Google Scholar
- 38.Ganesh R, Suresh N, Sathiyasekaran M. Celiac disease, still an uncommon problem in Tamilians? Indian J Gastroenterol. 2009;28:189.Google Scholar