S1562 Subclinical Celiac Disease in the U.S. Hispanic Population: Results From the Los Angeles County Department of Health Services

Abstract

Introduction: Anemia is a common extraintestinal manifestation of celiac disease (CeD). Although perceived as a predominantly White disease with a 1% prevalence, CeD also affects other underreported populations, such as the Hispanic population. We aimed to estimate the prevalence of CeD in Hispanic patients presenting with unexplained anemia. Methods: A cross-sectional study was completed through a clinical management database and electronic medical record after receiving Institution Review Board approval. Adult Hispanic patients with unexplained anemia who underwent upper endoscopy with duodenal biopsies between 2013 and 2020, were included. This study was conducted at the Los Angeles County Department of Health Services, a safety-net public health care system with a predominantly Hispanic (65%) population. Electronic medical records were queried for the diagnosis of biopsy-proven CeD. Results: Two hundred six subjects underwent upper endoscopy for unexplained anemia, of which 61 were excluded (18 underwent an upper endoscopy without biopsy, 7 were non-Hispanic, and 36 patients had normal hemoglobin levels; Table). Among all Hispanic patients referred for endoscopic evaluation of unexplained anemia (N = 145), the mean age was 53.9 years, and 66% were female. The overall prevalence of biopsy-proven CeD was 4.8% (N = 7/145). In patients with iron-deficiency anemia (IDA) specifically, the prevalence of CeD was 4.5% (N = 3/67). Of the 7 patients with confirmed CeD, only one in retrospect had associated diarrhea. None of the patients had a family history of CeD. Interestingly, only one of 5 tested patients had positive IgA tissue transglutaminase antibody, and the remainder were seronegative. Other CeD-related laboratory testing including vitamin B12 and liver function tests were unremarkable; thyroid stimulating hormone (TSH) levels were within normal range except for one patient with elevated levels due to poorly controlled hypothyroidism. Conclusion: The prevalence of CeD in adult Hispanic patients with unexplained anemia (unspecified or IDA) is similar to the prevalence in White patients, a finding not previously reported in the literature. Screening for CeD in patients with unexplained anemia in general, and IDA specifically, is of value in Hispanic patients as well as White ones. Seronegative CeD requires endoscopic evaluation with duodenal biopsies for diagnosis. Table 1. - Clinical and Lab Characteristics of Patients with Biopsy-Confirmed Celiac Disease tTG: IgA tissue transglutaminase within <4 months from index endoscopy; TSH: thyroid stimulating hormone; M: male; F: female; AST: aspartate aminotransferase; ALT: alanine transaminase ID Hemoglobin (Ferritin) AST/ALT Total Bilirubin IgA tTG Vitamin B12 TSH Other Comorbidities 49 F 8.5 33/17 0.5 None 652 12.8 Hypothyroidism, Rheumatoid arthritis on sulfasalazine and methotrexate 42 F 11.6 (70.7) None None < 1 596 None Refractory GERD s/P fundoplication 57 F 8.4 (7.6) 42/51 0.6 >100 NA None Hypothyroidism, Chronic hepatitis C 34 F 11.7 16/12 0.6 < 1 325 None None 40 M 10.7 29/40 0.6 None 481 0.83 Substance abuse, Coronary artery disease with NSTEMI, Osteoporosis 50 F 9.9 (5.4) 22/23 0.5 < 1 291 2.1 Stage II breast cancer 44 F 9.5 (3.1) 29/33 0.6 < 1 NA 1 Type II diabetes