Role of Routine Duodenal Biopsy in Patients with Unexplained Iron Deficiency Anemia in Areas of Low Prevalence of Celiac Disease

Aims: To assess the usefulness of routine duodenal biopsies in patients presenting with iron deficiency anemia in area with low prevalence of celiac disease.

Methods: This prospective study included 156 patients with unexplained iron deficiency anemia, referred to the Department of Gastroenterology, JSS Medical College and Hospital, Mysuru, India. All patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Celiac disease was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten-free diet (GFD). Also, patients were evaluated for IgA anti-tissue transglutaminase (t-TG) antibody with enzyme-linked immunosorbent assay (ELISA) technique.

Results:

A total of 156 patients were included in the study with mean age of 52.17 ± 16.01 (67.7% female) underwent endoscopic duodenal biopsy. Three (1.9%) were diagnosed to have celiac disease on biopsy which was confirmed with serological test (IgA Anti tTg) . Positivity for celiac disease did not correlate with severity of anemia or gastrointestinal symptoms.

Conclusions: Celiac disease should be considered in patients presenting with unexplained iron deficiency anemia, even if not accompanied with gastrointestinal symptoms. Doing initial serological testing followed by duodenal biopsy may be an appropriate approach, especially in areas with low prevalence of celiac disease. Routine duodenal biopsies did not seem to be a reasonable approach considering cost-effectiveness and its clinical utility .

	Mean	Std. Deviation
Age (in years)	52.17	16.02
HB (gm/dL)	6.63	1.93
PCV	22.76	6.06
SR iron (µg/dL)	21.27	14.82
TIBC (µg/dL)	428.56	147.42
SR ferritin (ng/mL)	21.62	51.51
IgA TTG (U/mL)	39.33	9.02

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Artikel online veröffentlicht:
22. April 2024