Karnam Umaprasanna S, Felder Lewis R, Raskin Jeffrey B
Division of Gastroenterology, University of Miami School of Medicine, Jackson Memorial Medical Center, Miami, FL 33136, USA.
South Med J. 2004 Jan;97(1):30-4. doi: 10.1097/01.SMJ.0000051059.23259.56.
Occult celiac disease has been reported in 0 to 6% of adults presenting with iron-deficiency anemia. Most prior studies have been retrospective or screened only a selected population of patients with small bowel biopsies. To more accurately define the true prevalence of this disorder in patients presenting with iron-deficiency anemia (with or without stool hemoccult positivity), we initiated this prospective study.
Esophagogastroduodenoscopy with small bowel biopsies and colonoscopy were performed in all iron-deficiency anemia patients (including those with hemoccult-positive stools) referred to the gastroenterology service during a 2-year period (1998-2000). Inclusion criteria included iron-deficiency anemia as defined by a serum ferritin < 25 ng/ml and anemia with hemoglobin < 12 g/dl. Patients were excluded for documented prior erosive, ulcerative, or malignant disease of the gastrointestinal tract, previous gastrointestinal surgery, overt gastrointestinal bleeding within the past 3 months, or inability to access the duodenum for biopsy. All patients underwent upper endoscopy with more than two biopsies of the distal duodenum and colonoscopy. A serum immunoglobulin A antiendomysial antibody test was to be performed in those patients with a positive small bowel biopsy to confirm the diagnosis of celiac disease.
One hundred five of 139 consecutive patients with iron-deficiency anemia met the inclusion criteria and were enrolled in the study. Fifty-seven men (mean age, 51.6 yr) and 48 women (mean age, 54.1 yr) constituted the study population. The demographics of this study population included 36 blacks, 38 Hispanics, and 22 whites. Nine patients were of mixed or unknown ethnic background. Forty-three and eight-tenths percent of the men and 37.5% of women had hemoccult-positive stools, accounting for a total of 40.9% of the study patients. Upper endoscopic findings included gastritis in 22.8%, gastric ulcers in 9.5%, duodenitis in 8.5%, esophagitis in 7.6%, Barrett's ulcer in 2.8%, duodenal ulcer in 2.8%, gastric polyp in 2.8%, and celiac disease in 2.8%. Colonoscopic findings included colon polyps in 21.9%, diverticula in 10.4%, and hemorrhoids in 16.1%. Multiple findings were found in 32.3% of patients, and there were no findings in 28.5% of patients.
The prevalence of occult celiac disease in this prospective study of patients presenting with iron-deficiency anemia was 2.8%. A significant number of other gastrointestinal lesions amenable to therapy were also found on upper and lower endoscopy in these patients. Given the treatable nature of celiac disease, it should be screened for in patients with unexplained iron-deficiency anemia with or without hemoccult-positive stools.
据报道，在患有缺铁性贫血的成年人中，隐匿性乳糜泻的发病率为0%至6%。大多数先前的研究都是回顾性的，或者仅对一小部分进行小肠活检的患者进行筛查。为了更准确地确定这种疾病在患有缺铁性贫血（无论粪便潜血是否呈阳性）患者中的真实患病率，我们开展了这项前瞻性研究。
在两年期间（1998 - 2000年），对所有转诊至胃肠病科的缺铁性贫血患者（包括粪便潜血阳性者）进行食管胃十二指肠镜检查及小肠活检和结肠镜检查。纳入标准包括血清铁蛋白<25 ng/ml定义的缺铁性贫血以及血红蛋白<12 g/dl的贫血。排除标准为有记录的既往胃肠道糜烂、溃疡或恶性疾病、既往胃肠道手术史、过去3个月内明显的胃肠道出血，或无法进行十二指肠活检。所有患者均接受了上消化道内镜检查，对十二指肠远端进行了两次以上活检，并进行了结肠镜检查。对小肠活检呈阳性的患者进行血清免疫球蛋白A抗肌内膜抗体检测，以确诊乳糜泻。
139例连续的缺铁性贫血患者中有105例符合纳入标准并被纳入研究。研究人群包括57名男性（平均年龄51.6岁）和48名女性（平均年龄54.1岁）。该研究人群的人口统计学特征包括36名黑人、38名西班牙裔和22名白人。9名患者为混合或不明种族背景。43.8%的男性和37.5%的女性粪便潜血呈阳性，占研究患者总数的40.9%。上消化道内镜检查结果包括胃炎22.8%、胃溃疡9.5%、十二指肠炎8.5%、食管炎7.6%、巴雷特溃疡2.8%、十二指肠溃疡2.8%、胃息肉2.8%、乳糜泻2.8%。结肠镜检查结果包括结肠息肉21.9%、憩室10.4%和痔疮16.1%。32.3%的患者有多种检查结果，28.5%的患者未发现异常。
在这项对缺铁性贫血患者的前瞻性研究中，隐匿性乳糜泻的患病率为2.8%。在这些患者的上消化道和下消化道内镜检查中还发现了大量其他可治疗的胃肠道病变。鉴于乳糜泻的可治疗性，对于不明原因的缺铁性贫血患者，无论粪便潜血是否呈阳性，都应进行筛查。
