Indian Pediatrics

, Volume 55, Issue 1, pp 31–34 | Cite as

Celiac Disease in Children with Moderate-to-Severe Iron-deficiency Anemia

  • Manish Narang
  • Ravikumar Natarajan
  • Dheeraj Shah
  • Amarender Singh Puri
  • Vikas Manchanda
  • Mrinalini Kotru
Open Access
Research Paper



To evaluate the proportion of children with moderate to severe iron-deficiency anemia who have associated celiac disease.


This cross-sectional analytical study was conducted among children aged 1 to 12 years of age with moderate-to-severe iron deficiency anemia and control children without anemia.Serum IgA-tissue trans-glutaminase levels were assessed in both cases and controls. All children with positive celiac serology underwent upper gastrointestinal endoscopy and duodenal biopsy; biopsy finding of Marsh grade 3 was considered positive for celiac disease.


There were 152 anemic children and 152 controls with mean (SD) hemoglobinof 7.7 (1.8) and 12.2 (0.74) g/dL, respectively. 16 (10.5%) cases and 3 (2%) control patients had positive serology for celiac disease [OR (95% CI) 5.33 (1.52-18.67), P=0.007]. Six (3.9%) children with iron-deficiency anemia and none of the controls had biopsy features diagnostic of celiac disease.


In the Northern Indian tertiary-care hospital outpatient setting, Celiac disease was associated with 4% of children presenting with moderate-to-severe anemia.


Biopsy Diagnosis Endoscopy Transglutaminases 


  1. 1.
    Kavimandan A, Sharma M, Verma AK, Das P, Mishra P, Sinha S, et al. Prevalence of celiac disease in nutritional anemia at a tertiary care center. Indian J Gastroenterol. 2013;33:114–8.CrossRefPubMedGoogle Scholar
  2. 2.
    National Family Health Survey-4, 2015-16: India Fact Sheet. Ministry of Health and Family Welfare. Available from: Accessed April 2, 2017.Google Scholar
  3. 3.
    Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, et al. Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology. J Pediatr Gastroenterol Nutr. 2005;40:1–19.CrossRefPubMedGoogle Scholar
  4. 4.
    World Health Organization: Department of Nutrition for Health and development; Haemoglobin concentration for the Diagnosis of Anaemia and Assessment of Severity. Geneva, WHO, 2011. (WHO/NMH/NHD/MNM/11.1). Available from: http://apps. who. int/iris/bitstream/ 10665/101179/1/WHO_NMH_NHD_EPG_14.1_eng. pdf. Accessed December 27, 2016.Google Scholar
  5. 5.
    World Health Organization: Serum Ferritin Concentrations for the Assessment of Iron Status and Iron Deficiency in Populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011. (WHO/NMH/NHD/MNM/11.2). Available from: http://www.who. int/vmnis/indicators/serum_ferritin. pdf. Accessed December 27, 2016.Google Scholar
  6. 6.
    Bainton DF, Finch CA. The diagnosis of iron deficiency anemia. Am J Med. 1964;37:62–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol. 1995;9:273–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Kalayci AG, Kanber Y, Birinci A, Yildiz L, Albayrak D. The prevalence of coeliac disease as detected by screening in children with iron deficiency anaemia. Acta Paediatr. 2005;94:678–81.CrossRefPubMedGoogle Scholar
  9. 9.
    Ertekin V, Tozun MS, Küçük N. The prevalence of celiac disease in children with iron-deficiency anemia. Turk J Gastroenterol. 2013;24:334–8.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2018

Authors and Affiliations

  • Manish Narang
    • 1
  • Ravikumar Natarajan
    • 1
  • Dheeraj Shah
    • 1
  • Amarender Singh Puri
    • 2
  • Vikas Manchanda
    • 3
  • Mrinalini Kotru
    • 4
  1. 1.Division of Pediatric Gastroenterology, Department of PediatricsUniversity College of Medical Sciences and GTB HospitalDelhiIndia
  2. 2.Department of GastroenterologyGB Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
  3. 3.Department of Clinical Microbiology and Infectious DiseasesChacha Nehru Bal ChikitsalayaDelhiIndia
  4. 4.Department of PathologyUniversity College of Medical Sciences and GTB HospitalDelhiIndia

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