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Celiac Disease and Iron-Deficiency Anemia

Diet iron is absorbed by the proximal small intestine, the site of greatest damage in CD. It is not surprising therefore, that iron-defi ciency anemia is a common fi nding in newly diagnosed CD. It also usually resolves with the institution of a GFD.

Several studies from Europe and North America have suggested that iron-deficiency anemia may be the sole manifestation of celiac disease in the absence of diarrhea. This association may be especially high in those unresponsive to oral iron therapy.

Iron deficiency is common in the general population. If it occurs in young women, it is often ascribed to excess menstrual loss, an empiric therapy with oral iron supplementation is started. However, older patients or those with anemia that is refractory to treatment are often investigated further.

Similarly, the persistence of anemia after menopause may be an important clue that leads to the detection of CD. Indeed, female patients have undergone hysterectomies to treat the iron defi ciency that persisted until the correct diagnosis was made. Anemia is rarely sought or diagnosed in children; in fact, hemoglobin is not routinely measured in children.

Nevertheless, iron-defi ciency anemia is a very common illness in primary care and often does not spur investigation in the younger patients. The prevalence of celiac disease in patients referred to GI endoscopy for investigation of iron-defi ciency anemia varies from 3% to 12%.

Clinicians should consider celiac disease as a possible, although not common, cause of unexplained anemia, and gastroenterologists should biopsy the duodenum when an endoscopy is performed in patients with iron-deficiency anemia, even if biopsies are not specifi cally required.

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