Zamani Farhad, Mohamadnejad Mehdi, Shakeri Ramin, Amiri Afsaneh, Najafi Safa, Alimohamadi Seyed-Meysam, Tavangar Seyed-Mohamad, Ghavamzadeh Ardeshir, Malekzadeh Reza
Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
World J Gastroenterol. 2008 Dec 28;14(48):7381-5. doi: 10.3748/wjg.14.7381.
To determine the prevalence of gluten sensitive enteropathy (GSE) in a large group of patients with iron deficiency anemia (IDA) of obscure origin.
In this cross-sectional study, patients with IDA of obscure origin were screened for GSE. 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 4120 IDA patients referred to our Hematology departments, 206 (95 male) patients were found to have IDA of obscure origin. Thirty out of 206 patients (14.6%) had GSE. The mean age of GSE patients was 34.6 +/- 17.03 (range 10-72 years). The female to male ratio was 1.3:1. 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 (e.g. no villous atrophy) 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.
There is a high prevalence (e.g. 14.6%) 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.
确定一大群不明原因缺铁性贫血（IDA）患者中麸质敏感性肠病（GSE）的患病率。
在这项横断面研究中，对不明原因IDA患者进行GSE筛查。评估抗肌内膜抗体（EMA）和组织转谷氨酰胺酶抗体（tTG）水平，并根据Marsh分类法对十二指肠活检标本进行取材和评分。GSE的诊断基于血清学检测阳性和十二指肠组织学异常。建议所有GSE患者采用无麸质饮食（GFD）。
在转至我院血液科的4120例IDA患者中，发现206例（95例男性）为不明原因IDA。206例患者中有30例（14.6%）患有GSE。GSE患者的平均年龄为34.6±17.03岁（范围10 - 72岁）。男女比例为1.3:1。16例患者有Marsh 3级病变，12例有Marsh 2级病变，2例有Marsh 1级病变。贫血的严重程度与十二指肠病变的严重程度平行。22例GSE患者（73.3%）无胃肠道症状。14例坚持GFD且未接受铁补充剂的GSE患者同意接受随访。GFD 6个月后，他们的平均血红蛋白水平（Hb）从9.9±1.6 g/dL升至12.8±1.0 g/dL（P<0.01）。有趣的是，14例十二指肠活检有Marsh 1/2级病变（如无绒毛萎缩）的患者中有6例，在未接受任何铁补充剂的情况下，平均Hb从11.0±1.1 g/dL升至13.1±1.0 g/dL（P<0.01）。
不明原因IDA患者中GSE的患病率较高（如14.6%）。无麸质饮食可改善十二指肠病变较轻且无绒毛萎缩的GSE患者的贫血状况。
