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Prevalence Of Gluten-Sensitive Enteropathy In Iron-Deficient Anemia Patients

January 1, 2009

Gluten sensitive enteropathy (GSE) is an autoimmune enteropathy due to food gluten intolerance in genetically predisposed people. While GSE was thought to be a rare disease in the past and was believed to be essentially a disease of Europeans, recent screening studies showed that GSE is one of the most frequent genetically based diseases occurred worldwide. Iron deficiency anemia could be a sole manifestation of GSE, and it might result in the delayed diagnosis of GSE, resulting in complications.

A research team led by Prof. Reza Malekzadeh studied the prevalence of gluten sensitive enteropathy (GSE) in a large group of patients with iron deficiency anemia (IDA) of obscure origin. Their findings will be published on December 28, 2008 in the World Journal of Gastroenterology.

In this prospective study, 4120 patients with IDA were enrolled in this study. Anti-endomysial antibody (EMA) and tissue transglutaminase antibody (tTG) levels were evaluated and duodenal biopsies were taken and scored according to the Marsh classification. The diagnosis of GSE was based on a positive serological test and abnormal duodenal histology. Gluten free diet (GFD) was advised for all the GSE patients.

Of the 4 120 IDA patients, 206 (95 male) patients were found to have IDA of obscure origin. Thirty out of 206 patients (14.6%) had GSE. Sixteen patients had Marsh 3, 12 had Marsh 2, and 2 had Marsh 1 lesions. The severity of anemia was in parallel with the severity of duodenal lesions. Twenty-two GSE patients (73.3%) had no gastrointestinal symptoms. Fourteen GSE patients who adhered to GFD without receiving iron supplementation agreed to undergo follow up visits. After 6 mo of GFD, their mean hemoglobin levels (Hb) increased from 9.9 ± 1.6 to 12.8 ± 1.0 g/dL (P < 0.01). Interestingly, in 6 out of 14 patients who had Marsh 1/2 lesions on duodenal biopsy, mean Hb increased from 11.0 ± 1.1 to 13.1 ± 1.0 g/dL (P < 0.01) while they did not receive any iron supplementation. These results indicate that there is a high prevalence of GSE in patients with IDA of obscure origin. Gluten free diet can improve anemia in GSE patients who have mild duodenal lesions without villous atrophy.

Reference: Zamani F, Mohamadnejad M, Shakeri R, Amiri A, Najafi S, Alimohamadi SM, Tavangar SM, Ghavamzadeh A, Malekzadeh R. Gluten sensitive enteropathy in patients with iron deficiency anemia of unknown origin. World J Gastroenterol 2008; 14(48): 7381-7385

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