INTRODUCTION: Iron deficiency anemia (IDA) is the most common form of anemia worldwide and can present with malabsorption symptoms. Current guidelines recommend performing both upper and lower endoscopies with biopsies for patients with iron deficiency anemia. Studies show that for celiac disease pooled diagnostic yield of duodenal biopsies in IDA is around 1.15%. The primary aim of this study is to determine the diagnostic yield of routine duodenal biopsies for celiac disease in patients with IDA and malabsorprtion symptoms. METHODS: A retrospective chart review was performed of patients undergoing EGD with duodenal biopsy as work up of IDA. All duodenal biopsies were performed from 1/1/2011-4/26/2019 at an academic tertiary referral center. Inclusion criteria was ferritin < / = 45ng/mL within 1 year prior to EGD. If ferritin data was unavailable, physician records were reviewed for diagnosis of iron deficiency anemia in patients who had proven serum MCV < 80 um3 within 1 year prior to EGD. Charts were then reviewed for reported malabsorption symptoms, n = 166. Malabsorption symptoms included abdominal pain and bloating. Patients with rectal bleeding, history of Crohn’s disease, Ulcerative colitis, gastrointestinal cancer, lymphoma or abdominal surgery leading to malabsorption were excluded. A diagnosis of celiac disease was defined as a Marsh type 2 or greater on tissue biopsy. Data on patients that had tissue transglutaminase IgA was (TTG-IGA) was also collected. Diagnostic yield for celiac disease was determined for patients who reported malabsorption symptoms. RESULTS: The median age of patients was 57.5 ± 16.8, of whom 25% were female. Symptoms included abdominal pain (22%), bloating (6%), diarrhea (11%) or weight loss (13%). 54% of the sample was white, 20% were Hispanic and 13% were black. Average Hgb was 9.3 ± 2.1, MCV was 76.1 ± 8.5 and ferritin was 22.9 ± 45.9. 31% of the sample had DM2, 10% had CAD, 11% had CKD, 8% had atrial fibrillation and 5% had cirrhosis. The diagnostic yield of duodenal biopsy in respect to celiac disease was 4.2%. The overall diagnostic yield in symptomatic patients with positive TTG IGA was 17%. CONCLUSION: Diagnostic yield of routine duodenal biopsies for identifying patients with celiac disease in setting of IDA is low. In patients with malabsorption symptoms, the diagnostic yield of routine duodenal biopsies remains less than 5%. These results suggest that alternative diagnoses should be considered in these patients.