Iron Deficiency Anemia in Celiac Disease

Talarico, Valentina; Giancotti, Luigino Antonio; Mazza, Giuseppe; Miniero, R; Bertini, Marco

doi:10.3390/nu13051695

Cited by 41 publications

(38 citation statements)

References 73 publications

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“…It can co-occur with other symptoms or even be the only manifestation of the disease [ 19 ]. The reported prevalence of iron deficiency and IDA in CD varies between studies, depending on study design, population and patient age [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

TMPRSS6 rs855791 Polymorphism Status in Children with Celiac Disease and Anemia

et al. 2021

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Celiac disease (CD) is an autoimmune chronic inflammatory disease occurring in genetically predisposed individuals in response to the intake of gluten. Clinical presentation can be heterogeneous. Iron-deficient anemia (IDA) is one of the most common extra-intestinal manifestations of CD. Although IDA usually reverts with a gluten-free diet (GFD), some patients show persistent IDA, the mechanisms of which are poorly understood. Recent studies suggest an association between the rs855791 polymorphism in the TMPRSS6 gene and persistent IDA in adults with CD. The current study aimed to assess the potential link between rs855791 and persistent IDA in pediatric patients with CD. The study included 106 children diagnosed with CD between 2015 and 2019. Clinical and blood parameters (including blood count, serum iron) were collected at diagnosis and after ≥12 months of GFD, and the rs855791 genotype was assessed for each patient. IDA was present at diagnosis in 25 patients (23.6%); only three (3%) had persistent IDA after GFD. The prevalence of rs855791 genotypes was 9% (n = 10) for TT, 53% (n = 56) for CT, and 38% (n = 40) for CC. There was a tendency toward a higher proportion of the T allele in patients with IDA and lower hemoglobin in the TT genotype but without statistical significance. An association between rs855791 and persistent IDA was not observed. These findings suggest that persistent IDA is uncommon in pediatric patients with CD. The prevalence of rs855791 in children with CD is reported for the first time.

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Section: Discussionmentioning

confidence: 99%

TMPRSS6 rs855791 Polymorphism Status in Children with Celiac Disease and Anemia

et al. 2021

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“…Although anemia is still a common presentation of CD, nutritional deficiencies alone do not explain this phenomenon in all cases, and CD has also been associated with other causes of anemia, such as anemia of chronic disease [4,64,[104][105][106]. Systemic inflammation, subsequent to the increase in blood levels of inflammatory proteins, is a rare event in patients with CD.…”

Section: Anemia Of Chronic Diseasementioning

confidence: 99%

“…Thus, the combination of anemia associated with high serum ferritin and evidence of systemic inflammation suggests anemia of chronic disease [64]. Figure 3 illustrates the mechanisms involved in the pathogenesis of anemia of chronic disease [4,64,79,105,106]. In CD there is a component of systemic inflammation which in some cases may also contribute to the pathogenesis of anaemia.…”

Section: Anemia Of Chronic Diseasementioning

confidence: 99%

“…Blood loss due to inflammatory lesions of intestinal mucosa may contribute to IDA in celiac patients [4,106]. Such is the case for patients with concomitant inflammatory bowel disease (IBD) [114], as well as those who have developed refractory celiac disease (RCD) and/or associated complications, including enteropathy associated with T-cell lymphoma (EATL), adenocarcinoma, jejunoileitis, or B-cell lymphoma [115,116].…”

Section: Blood Loss Due To Inflammatory Lesionsmentioning

confidence: 99%

“…Low ferritin levels represent an early and highly specific indicator of iron deficiency. However, the international criteria for defining depleted iron deposits vary with age: <12 µg/L for children under five years of age and equal to 15-20 µg/L for those over 5 fiveyears of age and adults [106]. These levels should be adjusted upwards in the presence of inflammation or infection, so that the cut-off for the diagnosis of IDA rises to 30-50 µg/L in this context.…”

Section: Management Of Anemia and Iron Deficiency In Different CD Settings (Algorithms) 81 At The Time Of Cd Disease Diagnosismentioning

confidence: 99%

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Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management

Montoro

Santolaria-Piedrafita

Cañamares-Orbís

et al. 2021

Nutrients

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Iron is an essential nutrient to life and is required for erythropoiesis, oxidative, metabolism, and enzymatic activities. It is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis, and it promotes the growth of immune system cells. Thus, iron deficiency (ID) leads to deleterious effects on the overall health of individuals, causing significant morbidity. Iron deficiency anemia (IDA) is the most recognized type of anemia in patients with celiac disease (CD) and may be present in over half of patients at the time of diagnosis. Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients. The decision to replenish iron stores and the route of administration (oral or intravenous) are controversial due, in part, to questions surrounding the optimal formulation and route of administration. This paper provides an algorithm based on the severity of symptoms; its impact on the health-related quality of life (HRQL); the tolerance and efficiency of oral iron; and other factors that predict a poor response to oral iron, such as the severity of histological damage, poor adherence to GFD, and blood loss due to mucosal lesions.

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Longitudinal screening of HLA‐risk and HLA‐nonrisk children for celiac disease to age 15 years: CiPiS study

Boström,

Brundin,

Björck

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesAutoantibodies against tissue transglutaminase (tTG) are serological markers of celiac disease. The aim was to study the applicability of human leukocyte antigen (HLA)‐genotyping and tTG autoantibodies in the screening of celiac disease in a longitudinal birth cohort followed to age 15 years.MethodsIncluded were 13,860 HLA‐DQ‐genotyped children at birth and previously invited to a screening at age 3 and 9 years, respectively. HLA‐DQB1*02 and/or DQB1*03:02 (HLA‐risk) children were compared with non‐HLA‐DQB1*02 and non‐DQB1*03:02 (HLA‐nonrisk) children. The present study reinvited 12,948/13,860 (93.4%) children at age 15 years of whom 1056/2374 (44.5%) participated in screening at both age 3 and 9 years. Both immunoglobulin A (IgA) and G (IgG) autoantibodies against tTG were analyzed separately in radiobinding assays. Persistently tTG autoantibody‐positive children were examined with intestinal biopsy to confirm the diagnosis of celiac disease.ResultsAt age 3 years, celiac disease was diagnosed in 56/1635 (3.4%) HLA‐risk children compared with 0/1824 HLA‐nonrisk children (p < 0.001). By age 9 years, celiac disease was diagnosed in 72/1910 (3.8%) HLA‐risk children compared with 0/2167 HLA‐nonrisk children (p < 0.001). Screening at age 15 years detected 14/1071 (1.3%) HLA‐risk children positive for IgA‐tTG and/or IgG‐tTG of whom 12/1071 (1.1%) remained persistently positive. Among those, 10/1071 (0.9%, 95% confidence interval: 0.4%–1.7%) HLA‐risk children were diagnosed with celiac disease compared with 0/1303 HLA‐nonrisk children (p < 0.001) and 5/491 (1.0%) were negative in screenings at both 3 and 9 years of age.ConclusionsScreening for celiac disease needs to be performed at multiple timepoints to detect all cases but can be restricted to children at HLA‐risk.

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Iron Deficiency Anemia in Celiac Disease

Cited by 41 publications

References 73 publications

TMPRSS6 rs855791 Polymorphism Status in Children with Celiac Disease and Anemia

TMPRSS6 rs855791 Polymorphism Status in Children with Celiac Disease and Anemia

Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management

Longitudinal screening of HLA‐risk and HLA‐nonrisk children for celiac disease to age 15 years: CiPiS study

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