Kavimandan Amit, Sharma Meenakshi, Verma Anil K, Das Prasenjit, Mishra Prabhash, Sinha Sanjeev, Mohan Anant, Sreenivas V, Datta Gupta Siddhartha, Makharia Govind K
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
Indian J Gastroenterol. 2014 Mar;33(2):114-8. doi: 10.1007/s12664-013-0366-6. Epub 2013 Sep 1.
While anemia occurs in 80 % to 90 % of patients with celiac disease (CD), it may be the sole manifestation of CD. The prevalence of CD in Indian patients with nutritional anemia is not known.
Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy.
Ninety-six patients [mean ± SD age 32.1 ± 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean ± SD duration of diarrhea in them was 9.7 ± 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B12 deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration.
CD screening should be included in the work up of otherwise unexplained nutritional anemia.
虽然乳糜泻（CD）患者中80%至90%会出现贫血，但贫血可能是CD的唯一表现。印度营养性贫血患者中CD的患病率尚不清楚。
对出现营养性贫血的青少年和成年患者进行前瞻性筛查，使用IgA抗组织转谷氨酰胺酶抗体（抗tTG Ab），如果结果为阳性，则接着进行上消化道内镜检查和十二指肠活检。
共筛查了96例患者[平均±标准差年龄32.1±13.1岁，贫血中位病程11个月（范围1至144个月）]。这些患者中，80例为缺铁性贫血，11例为巨幼细胞贫血，5例为双相性贫血。73例患者正在接受补血药治疗，36.4%的患者接受过输血。19例有慢性腹泻病史，他们腹泻的平均±标准差病程为9.7±35.8个月。13例患者的IgA抗tTG Ab呈阳性，其中12例同意接受十二指肠活检。10例患者有绒毛萎缩（3例为马什3a级，1例为3b级，6例为3c级），2例没有。因此，10例营养性贫血患者（9例缺铁性贫血，1例维生素B12缺乏性贫血）被诊断为患有CD。多因素逻辑回归分析发现，年龄、症状持续时间和腹泻的存在是CD的预测因素。所有CD患者均采用无麸质饮食，并补充铁和维生素，血红蛋白浓度有显著改善。
对于原因不明的营养性贫血，检查工作应包括CD筛查。
