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

Abstract

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 positiveIgA 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 6months mean (SD) hemoglobin levels increased from 7.42 ± 0.96 to 10.47 ± 0.80g/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.