Refractory iron-deficiency anemia and gluten intolerance: Response to gluten-free diet

Abstract

Introduction: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common.Objectives: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients.Methods: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response.Results: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes.Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects.Conclusions: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development.

Comparative Profile of Celiac Disease Between Children and Adults in Western Algeria Region

“…The clinical symptomatology of the disease was characterized by classic forms that are defined as digestive disorders, which were predominant in children (69%), mainly chronic diarrhea (54.1%), abdominal pain (63.3%), and abdominal bloating (32.1%), with a significant difference (P = 0.004; P = 0.026, and P < 0.001, respectively), which is consistent with a study by Rodrigo-Saez et al (16) who noted that chronic diarrhea was the main feature of the disease in children. On the other hand, adults also expressed chronic diarrhea as the main symptom of the disease.…”

“…In the present study, there were many diseases associated with celiac disease in children and adults; however, in the adult group, Crohn's disease and hypothyroidism seem to be more frequent, as noted in the results of studies by Doya et al (19) and Baharvand et al (20). Rodrigo-Saez et al (16) suggested that most associated diseases in adults are of autoimmune origin. Unlike in the infant group, where allergy was followed by anemia as the main associated disease, Vivas et al (18) suggest that anemia is one of the associated diseases in infants and children.…”

Persistence of Anemia in Celiac Disease patients despite a Gluten Free Diet: A retrospective study

“…folate, vitamin B12) [32]. Some studies reported improved anemia in about 90% of patients with CD after starting GFD [35]. In our study, despite the mean HGB level increased after starting GFD, anemia prevalence didn't signi cative differ after 3-5 years of GFD.…”

“…First, duodenal mucosa recovery is faster and more complete in children than in adults [37]. Probably, the latter is partially due both to the diagnostic delay in adults and a greater GFD adherence of children compared to adults [35,38]. However, to clarify this hypothesis further studies are needed.…”

Factors Associated With Adherence to a Gluten-Free Diet in Celiac Patients Diagnosed in Childhood as Compared to Adulthood

“…Classic (gastrointestinal) symptoms were reported to be more frequent in pediatric patients, whereas extraintestinal manifestations were more common in adults CD patients. Therefore, diagnosing CD in adults might be more challenging (Poddar, 2013; Reilly et al, 2011; Rodrigo-Sáez et al, 2011; Vivas, Vaquero, Rodríguez-Martín, & Caminero, 2015; Vivas et al, 2008).…”