Abstract
Iron is an essential nutrient to life and is required for erythropoiesis, oxidative, metabolism, and enzymatic activities. It is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis, and it promotes the growth of immune system cells. Thus, iron deficiency (ID) leads to deleterious effects on the overall health of individuals, causing significant morbidity. Iron deficiency anemia (IDA) is the most recognized type of anemia in patients with celiac disease (CD) and may be present in over half of patients at the time of diagnosis. Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients. The decision to replenish iron stores and the route of administration (oral or intravenous) are controversial due, in part, to questions surrounding the optimal formulation and route of administration. This paper provides an algorithm based on the severity of symptoms; its impact on the health-related quality of life (HRQL); the tolerance and efficiency of oral iron; and other factors that predict a poor response to oral iron, such as the severity of histological damage, poor adherence to GFD, and blood loss due to mucosal lesions.
Highlights
Iron is an essential nutrient to life, and its role in biology is enormous [1,2,3]
These findings suggest that Iron deficiency anemia (IDA) is an important risk factor for Celiac disease (CD) irrespective of patient demographics, and that endoscopic small bowel biopsy should be a part of the diagnostic workup for the condition, even in patients in which other etiologies may be suspected
Such is the case for patients with concomitant inflammatory bowel disease (IBD) [114], as well as those who have developed refractory celiac disease (RCD) and/or associated complications, including enteropathy associated with T-cell lymphoma (EATL), adenocarcinoma, jejunoileitis, or B-cell lymphoma [115,116]
Summary
Iron is required for erythropoiesis, oxidative, metabolism, and enzymatic activities, and it is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis [4]. It promotes the growth of immune system cells. Iron deficiency (ID) is the most common deficiency state in the world, affecting more than two billion people globally It is prevalent in less-developed countries, it remains a significant problem in the developed world, where other forms of malnutrition have been almost eliminated [5].
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