Value of routine duodenal biopsy in diagnosing coeliac disease in patients with iron deficiency anaemia

Mandal, Aditya; Mehdi, Itrat; Munshi, S K; Lo, T C N

doi:10.1136/pgmj.2003.014670

Cited by 33 publications

(36 citation statements)

References 13 publications

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“…[63][64][65] Demonstration of histological changes in the small bowel mucosa is still regarded as the gold standard of diagnosis in celiac disease. 66,67 However, the discovery of antiendomysial antibodies in patients with celiac disease had a major impact on the screening and diagnostic algorithms for recognizing celiac disease. 68 Its specificity and sensitivity are estimated at 99% and over 90%, respectively.…”

Section: Celiac Diseasementioning

confidence: 99%

How I treat unexplained refractory iron deficiency anemia

Hershko

Camaschella

2014

Blood

133

140

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Endoscopic gastrointestinal workup fails to establish the cause of iron deficiency anemia (IDA) in a substantial proportion of patients. In patients referred for hematologic evaluation with unexplained or refractory IDA, screening for celiac disease, autoimmune gastritis, Helicobacter pylori, and hereditary forms of IDA is recommended. About 4% to 6% of patients with obscure refractory IDA have celiac disease, and autoimmune gastritis is encountered in 20% to 27% of patients. Stratification by age cohorts in autoimmune gastritis implies a disease presenting as IDA many years before the establishment of clinical cobalamin deficiency. Over 50% of patients with unexplained refractory IDA have active H pylori infection and, after excluding all other causes of IDA, 64% to 75% of such patients are permanently cured by H pylori eradication. In young patients with a history suggestive of hereditary iron deficiency with serum ferritin higher than expected for IDA, mutations involving iron trafficking and regulation should be considered. Recognition of the respective roles of H pylori, autoimmune gastritis, celiac disease, and genetic defects in the pathogenesis of iron deficiency should have a strong impact on the current diagnostic workup and management of unexplained, or refractory, IDA.

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Section: Celiac Diseasementioning

confidence: 99%

How I treat unexplained refractory iron deficiency anemia

Hershko

Camaschella

2014

Blood

133

140

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“…Recent guidelines from the British Society of Gastroenterology recommend that duodenal biopsies should be taken during endoscopy if no obvious cause of iron deficiency could be found (21).…”

Section: Patientsmentioning

confidence: 99%

The prevalence of celiac disease in children with iron-deficiency anemia

Ertekin¹,

Tosun²,

Küçük³

2013

Turk J Gastroenterol

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“…Although serological tests are reliable, endoscopic biopsies are essential in diagnosing the disease because they allow for direct observation of histologic abnormalities compatible with CD [1][2][3][4][5][6]. Therefore some centers encourage routine endoscopic biopsies in all patients with upper gastrointestinal symptomatology [7,8].…”

Section: Introductionmentioning

confidence: 99%

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

et al. 2013

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Background. European studies have shown the utility of limiting endoscopic biopsies to diagnose celiac disease (CD) to patients that have high-risk symptoms or present with positive serology. However, many centers in the U.S. have open access endoscopy. Patients are referred without prior serologic testing, and endoscopists often decide whether or not to biopsy at the time of procedure. Aims. Evaluate the yield of duodenal biopsies for the diagnosis of CD in patients undergoing upper endoscopy without prior serologic testing. Methods. This retrospective study evaluated the frequency of CD diagnosis based duodenal biopsies. Researchers were interested in the yield of endoscopic stigmata findings in patients with high-risk symptoms versus low risk. Results. Eight hundred and ten patients met entry criteria at the Cleveland Clinic Florida between 2004 and 2008; 320 presented with highrisk symptoms; and 490 low risk. Sixty-one (7.5%) displayed endoscopic stigmata, and 10/61 (16.3%) were diagnosed with CD. Only patients who exhibited endoscopic stigmata were later diagnosed based on histologic findings. The presence of endoscopic stigmata greatly increased the probability of diagnosing CD, with a positive likelihood ratio of 15.6. Conclusions. When performing upper endoscopy without known serological markers for CD, clinicians should limit duodenal biopsies to patients with high-risk symptoms or endoscopic stigmata.

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Value of routine duodenal biopsy in diagnosing coeliac disease in patients with iron deficiency anaemia

Cited by 33 publications

References 13 publications

How I treat unexplained refractory iron deficiency anemia

How I treat unexplained refractory iron deficiency anemia

The prevalence of celiac disease in children with iron-deficiency anemia

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

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