Abstract
Background: Iron deficiency anaemia (IDA) is a recognised feature of coeliac disease in adults and can be its only presentation.
Objective: To determine the yield of routine distal duodenal biopsies in diagnosing coeliac disease in adult and elderly patients with IDA whose endoscopy revealed no upper gastrointestinal cause of iron deficiency.
Study design: Prospective study in a teaching hospital endoscopy unit.
Method: Altogether 504 consecutive patients with IDA, aged 16–80 years, attending for endoscopy were included in this study. At least two distal duodenal biopsies were taken if endoscopy revealed no cause of iron deficiency.
Result: In nine (1.8%) patients duodenal biopsies revealed typical histological features of coeliac disease. Of these, five patients were above 65 years old.
Conclusion: In adult and elderly patients undergoing endoscopy for IDA, the endoscopist should take distal duodenal biopsies to exclude coeliac disease if no upper gastrointestinal cause of anaemia is found. Coeliac disease is not an uncommon cause of IDA in patients >65 years of age and a history of chronic diarrhoea increases diagnostic yield in this age group.
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Selected References
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- Ackerman Z., Eliakim R., Stalnikowicz R., Rachmilewitz D. Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol. 1996 Oct;91(10):2099–2102. [PubMed] [Google Scholar]
- Brocchi E., Corazza G. R., Caletti G., Treggiari E. A., Barbara L., Gasbarrini G. Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. N Engl J Med. 1988 Sep 22;319(12):741–744. doi: 10.1056/NEJM198809223191202. [DOI] [PubMed] [Google Scholar]
- Corazza G. R., Valentini R. A., Andreani M. L., D'Anchino M., Leva M. T., Ginaldi L., De Feudis L., Quaglino D., Gasbarrini G. Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia. Scand J Gastroenterol. 1995 Feb;30(2):153–156. doi: 10.3109/00365529509093254. [DOI] [PubMed] [Google Scholar]
- Depla A. C., Bartelsman J. F., Mulder C. J., Tytgat G. N. Anemia: monosymptomatic celiac disease. A report of 3 cases. Hepatogastroenterology. 1990 Feb;37(1):90–91. [PubMed] [Google Scholar]
- Dickey W., Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol. 1999 Aug;94(8):2182–2186. doi: 10.1111/j.1572-0241.1999.01348.x. [DOI] [PubMed] [Google Scholar]
- Gilmore Anna B., Collin Jeff. The world's first international tobacco control treaty. BMJ. 2002 Oct 19;325(7369):846–847. doi: 10.1136/bmj.325.7369.846. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hankey G. L., Holmes G. K. Coeliac disease in the elderly. Gut. 1994 Jan;35(1):65–67. doi: 10.1136/gut.35.1.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnston S. D., Watson R. G., McMillan S. A., Sloan J., Love A. H. Coeliac disease detected by screening is not silent--simply unrecognized. QJM. 1998 Dec;91(12):853–860. doi: 10.1093/qjmed/91.12.853. [DOI] [PubMed] [Google Scholar]
- Mäki M., Collin P. Coeliac disease. Lancet. 1997 Jun 14;349(9067):1755–1759. doi: 10.1016/S0140-6736(96)70237-4. [DOI] [PubMed] [Google Scholar]
- Parnell N. D., Ciclitira P. J. Review article: coeliac disease and its management. Aliment Pharmacol Ther. 1999 Jan;13(1):1–13. doi: 10.1046/j.1365-2036.1999.00448.x. [DOI] [PubMed] [Google Scholar]
- Radaelli F., Minoli G., Bardella M. T., Conte D. Celiac disease among patients referred for routine upper gastrointestinal endoscopy: prevalence and diagnostic accuracy of duodenal endoscopic markers. Am J Gastroenterol. 2000 Apr;95(4):1089–1090. doi: 10.1111/j.1572-0241.2000.01948.x. [DOI] [PubMed] [Google Scholar]
- Rockey D. C., Cello J. P. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med. 1993 Dec 2;329(23):1691–1695. doi: 10.1056/NEJM199312023292303. [DOI] [PubMed] [Google Scholar]
- Sulkanen S., Halttunen T., Laurila K., Kolho K. L., Korponay-Szabó I. R., Sarnesto A., Savilahti E., Collin P., Mäki M. Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology. 1998 Dec;115(6):1322–1328. doi: 10.1016/s0016-5085(98)70008-3. [DOI] [PubMed] [Google Scholar]