Association of Potential Celiac Disease and Refractory Iron Deficiency Anemia in Children and Adolescents

Shahriari, Mahdi; Honar, Naser; Yousefi, Ali Reza; Javaherizadeh, Hazhir

doi:10.1590/s0004-2803.201800000-15

Cited by 20 publications

(21 citation statements)

References 11 publications

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“…A cross-sectional study on 290 patients (age more than 12 years) diagnosed with IDA showed that tTGs were found in 32 (11%) of these patients (p = 0.0002) [35]. Shahriari et al studied 184 children: 92 patients with IDA responsive to iron supplementation, 45 patients with IDA unresponsive to iron supplementation, and 47 controls [36]. They found that the frequency of positive antibodies for CD was higher in the second group compared with the other two groups (p < 0.001).…”

Section: Iron Deficiency Anemia and Relationship With Clinical And Himentioning

confidence: 99%

Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet

et al. 2020

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Celiac disease (CD) is an autoimmune disorder characterized by intolerance to dietary gluten in genetically predisposed subjects. Iron deficiency anemia (IDA) is a common sign in CD, being the only abnormality in approximately 40% of celiac patients. A multifactorial etiology leads to IDA in CD. The two main causes are the villous atrophy of the mucosa at the site of iron absorption (the duodenum) and the resulting inflammation, which triggers the mechanism that leads to the anemia of chronic disease. Until now, it has been unclear why some patients with CD continue to have IDA despite a careful gluten-free diet (GFD) and the normalization of villous atrophy. Furthermore, some celiac patients are refractory to oral iron supplementation despite the healing of the mucosa, and they thus require periodic intravenous iron administration. The Marsh classification evaluates the degree of inflammation and villous atrophy, but it does not assess the possible persistence of ultrastructural and molecular alterations in enterocytes. The latter was found in CD in remission after adopting a GFD and could be responsible for the persistently reduced absorption of iron and IDA. Even in non-celiac gluten sensitivity, anemia is present in 18.5–22% of patients and appears to be related to ultrastructural and molecular alterations in intestinal microvilli. It is possible that a genetic component may also play a role in IDA. In this review, we evaluate and discuss the main mechanisms of IDA in CD and the possible causes of its persistence after adopting a GFD, as well as their therapeutic implications.

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Section: Iron Deficiency Anemia and Relationship With Clinical And Himentioning

confidence: 99%

Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet

et al. 2020

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“…Malabsorption causes should be considered especially in refractory IDA; this malabsorption can be the only manifestation in subclinical and silent CD [29,30]. The study of Shahriari et al [11] suggests serologic screening for CD in patients with refractory IDA to minimize the complications of CD and repeated iron treatment. A study [31] revealed a significant association between H. pylori infection and IDA in patients with CD, and Samasca et al [32] recommend performing the screening for H. pylori infection in patients with CD and ID, but currently there is no evidence to support this recommendation.…”

Section: Micronutrient Deficiencies and Celiac Diseasementioning

confidence: 99%

“…A recent meta-analysis found that more than 3% of patients with IDA have histological evidence of CD. This high percentage of subjects with IDA who are celiac, reinforces the need for screening CD in patients with IDA [11]. Folate and vitamin B 12 malabsorption, nutritional deficiencies, blood loss, inflammation, development of refractory CD or concomitant Helicobacter pylori infection are other causes of anemia in such patients [12] (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review

et al. 2019

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Celiac disease (CD) is a multisystemic disorder with different clinical expressions, from malabsorption with diarrhea, anemia, and nutritional compromise to extraintestinal manifestations. Anemia might be the only clinical expression of the disease, and iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of CD. Therefore, CD should be suspected in the presence of anemia without a known etiology. Assessment of tissue anti-transglutaminase and anti-endomysial antibodies are indicated in these cases and, if positive, digestive endoscopy and intestinal biopsy should be performed. Anemia in CD has a multifactorial pathogenesis and, although it is frequently a consequence of iron deficiency, it can be caused by deficiencies of folate or vitamin B 12 , or by blood loss or by its association with inflammatory bowel disease (IBD) or other associated diseases. The association between CD and IBD should be considered during anemia treatment in patients with IBD, because the similarity of symptoms could delay the diagnosis. Vitamin B 12 deficiency is common in CD and may be responsible for anemia and peripheral myeloneuropathy. Folate deficiency is a well-known cause of anemia in adults, but there is little information in children with CD; it is still unknown if anemia is a symptom of the most typical CD in adult patients either by predisposition due to the fact of age or because biochemical and clinical manifestations take longer to appear.

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“…Otherwise, heme-iron is absorbed in the same bowel district, but separately from DMT1 and more efficiently than inorganic iron [1][2][3]. This portion of the duodenum represents the most frequently destroyed region in CD, consequently resulting in a reduction in iron absorption, and therefore IDA, which is another of the most frequent extra-intestinal manifestations (EIM) of CD [5][6][7][8][9][10][11][12]. The prevalence of anemia, different due to the high variability of the studies on this topic, is estimated at between 12 and 82% in patients with new CD diagnosis and about 46% in patients affected by subclinical CD [5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Shahriari et al studied the prevalence of IDA in 184 children (92 patients with IDA responsive to iron supplementation, 45 patients with IDA unresponsive to iron supplementation). The authors showed a positive serology of CD in 5.4% and in 28.3% of children with responsive and refractory IDA, respectively [ 5 ]. Ertekin et al reported that among 61 children with IDA, 21.3% had positive serology for CD [ 28 ] and Karaman et al found positive serology for CD in about 8.4% of 250 children with IDA [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Iron Deficiency Anemia in Celiac Disease

et al. 2021

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The iron absorption process developsmainly in the proximal duodenum. This portion of the intestine is typically destroyed in celiac disease (CD), resulting in a reduction in absorption of iron and subsequent iron deficiency anemia (IDA). In fact, the most frequent extra-intestinal manifestation (EIM) of CD is IDA, with a prevalence between 12 and 82% (in relation with the various reports) in patients with new CD diagnosis. The primary treatment of CD is the gluten-free diet (GFD), which is associated with adequate management of IDA, if present. Iron replacement treatment historically has been based on oral products containing ferrous sulphate (FS). However, the absorption of FS is limited in patients with active CD and unpredictable in patients on a GFD. Furthermore, a poor tolerability of this kind of ferrous is particularly frequent in patients with CD or with other inflammatory bowel diseases. Normalization from anemic state typically occurs after at least 6 months of GFD, but the process can take up to 2 years for iron stores to replenish.

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Association of Potential Celiac Disease and Refractory Iron Deficiency Anemia in Children and Adolescents

Abstract: Frequency of potential celiac disease in patients with refractory IDA was higher than control the subjects. Therefore, we recommend serologic screening for early detection and minimizing the complications of celiac disease and repeated iron therapy for this group.

Cited by 20 publications

References 11 publications

Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet

Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet

Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review

Iron Deficiency Anemia in Celiac Disease

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