Prevalence of Coeliac Disease in Omani Adults with Iron Deficiency Anaemia of Unknown Cause: Case-finding study.

Safa Ambusaidi,Rahma Al Kindi,Al Manar Al Busaidi,Jalila Al Shekaili,Asma Al Salmani,Robin Davidson,Mahmood Al Kindi

doi:10.18295/squmj.5.2021.101

Abstract

ObjectivesThis study aimed to estimate the serological prevalence of coeliac disease in patients with iron deficiency anaemia (IDA) of unknown cause at a primary healthcare facility in Oman.MethodsThis prospective case-finding study was conducted at the primary care clinics in Sultan Qaboos University Hospital, Muscat, Oman from September 2018 to June 2020. Patients aged 18 to 55 years, with a haemoglobin (Hb) level <11.5 g/dL for males and <11.0 g/dL for females and a ferritin level <30 ng/mL for males and <13 ng/mL for females, were included in the study. Blood samples were obtained for initial serological screening using serum immunoglobulin (Ig)A level; those samples with normal levels of IgA, IgA anti-tissue transglutaminase antibody (tTG) and IgA anti-deamidated gliadin peptide (DGP) were determined. Positive IgA-tTG test was confirmed using IgA-endomysial antibodies. Patients with low IgA levels were tested using IgG-tTG and IgG-DGP.ResultsA total of 104 patients participated in this study. Eight patients (7.7%) were found to have a positive serological screening result for coeliac disease; of these patients, three (37.5%) had a positive IgA-tTG result. Two of those three (66.7%) had a positive IgA-endomysial antibody. The IgA-DGP result was positive in seven (6.7%) of the 104 patients. Out of those seven patients, two also had a positive IgA tTG.ConclusionCoeliac disease is not a rare disorder. There is a need to increase awareness among healthcare professionals about coeliac disease and its non-classical manifestations such as IDA.

Highlights

Celiac disease (CD) is a chronic autoimmune disorder of the small bowel that is triggered by exposure to dietary gluten
Application to Patient Care Celiac disease is not a rare disorder and it should be considered in patients with anemia especially when there is a positive family history of the disease. This can be done by assessment of IgA level followed by a combination of tests and deamidated gliadin peptide (DGP) based on the IgA deficiency status
A prospective case finding study was conducted at the students’ and the family medicine clinics in Sultan Qaboos University Hospital (SQUH) from September 2018 to June 2020. These two clinics are both under the Department of Family Medicine and Public Health, and provide primary care services to all Sultan Qaboos University (SQU) students and staff working in SQU and SQUH, and their families who come from all over Oman, and so the sample is representative of the whole country

Summary

Introduction

Celiac disease (CD) is a chronic autoimmune disorder of the small bowel that is triggered by exposure to dietary gluten. Multiple serological approaches have been described to help in the diagnosis of celiac disease. This includes assessment of IgA-endomysial antibody (EMA), IgA-tissue transglutaminase antibody (tTG), and IgA-deamidated gliadin peptide antibody (DGA).[3] In general, studies have shown that serum IgA-EMA and IgA-tTG testing have the highest diagnostic accuracy with a sensitivity of 95% and a specificity close to 100%.2. Genetic testing for human leukocyte antigen HLA-DQ2 and HLA-DQ8 have been used to help in resolving cases with high clinical suspicion with doubtful or discrepant serology or histology.[3] For a definitive diagnosis, upper esophagogastroduodenoscopy with a small bowel biopsy should be performed for any patient with positive serology or a high probability of having the disease (>5 percent), regardless of the serology results.[6]

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