Indian Journal of Gastroenterology

, Volume 34, Issue 4, pp 314–319 | Cite as

Prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin in Kashmir (India)

  • Gul JavidEmail author
  • Shaheen Nazir Lone
  • Abid Shoukat
  • Bashir Ahmed Khan
  • Gulam Nabi Yattoo
  • Altaf Shah
  • Jaswinder Singh Sodi
  • Mushtaq Ahmed Khan
  • Showkat Ali Zarger
Original Article



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.


Celiac 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.

Ethics statement

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


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Copyright information

© Indian Society of Gastroenterology 2015

Authors and Affiliations

  • Gul Javid
    • 1
    Email author
  • Shaheen Nazir Lone
    • 1
  • Abid Shoukat
    • 1
  • Bashir Ahmed Khan
    • 1
  • Gulam Nabi Yattoo
    • 1
  • Altaf Shah
    • 1
  • Jaswinder Singh Sodi
    • 1
  • Mushtaq Ahmed Khan
    • 1
  • Showkat Ali Zarger
    • 1
  1. 1.Department of GastroentrologySher-I-Kashmir Institute of Medical SciencesSrinagarIndia

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