Shahriari Mahdi, Honar Naser, Yousefi Ali, Javaherizadeh Hazhir
Pediatric Hematology and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran.
Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Arq Gastroenterol. 2018 Jan-Mar;55(1):78-81. doi: 10.1590/S0004-2803.201800000-15.
Celiac disease is an enteropathy caused by dietary gluten. The combination of serologic, genetic and histologic data has led to description of other categories of this disease.
There are a number of patients with iron deficiency anemia (IDA) that do not respond to iron treatment and may be repeated for many times, Therefore, we aimed to investigate celiac disease in this group.
In this cross sectional transverse prospective study from August 2011 to February 2013, in a Pediatric care clinic affiliated to Shiraz University of Medical Sciences, 184 children including 92 IDA patients who responded to treatment using iron supplement, 45 non-responding iron deficient patients, and 47 healthy individuals, with the maximum age of 18 years, with written consent from their parents, participated in serologic screening (with Anti-TTG antibody and anti-Endomysial antibody) for celiac disease. Patients with at least one positive serology test underwent multiple mucosal biopsy from bulb and duodenum.
Among 184 participants, 19 (10.3%) subjects had positive serologic test for celiac disease, including 13 (28.9%) patients in the group with refractory IDA, 5 (5.4%) patients in the group with treated IDA, and 1 patient in the healthy group. The frequency of positive serologic test in the group with IDA resistant to treatment was prominently higher than the other two groups (P<0.001). Among the patients with positive serologic celiac test who underwent endoscopy and biopsy, no histologic evidence of celiac disease was seen. They were diagnosed as potential celiac disease.
Frequency of potential celiac disease in patients with refractory IDA was higher than control the subjects. Therefore, we recommend serologic screening for early detection and minimizing the complications of celiac disease and repeated iron therapy for this group.
乳糜泻是一种由膳食麸质引起的肠病。血清学、遗传学和组织学数据的结合导致了该疾病其他类型的描述。
有许多缺铁性贫血（IDA）患者对铁治疗无反应且可能多次反复，因此，我们旨在调查该组患者中的乳糜泻情况。
在2011年8月至2013年2月进行的这项横断面横向前瞻性研究中，在设拉子医科大学附属的一家儿科护理诊所，184名儿童参与了乳糜泻的血清学筛查（使用抗组织转谷氨酰胺酶抗体和抗肌内膜抗体），其中包括92名对铁补充剂治疗有反应的IDA患者、45名无反应的缺铁患者以及47名健康个体，最大年龄为18岁，均获得了其父母的书面同意。血清学检测至少一项呈阳性的患者接受了来自球部和十二指肠的多次黏膜活检。
在184名参与者中，19名（10.3%）受试者乳糜泻血清学检测呈阳性，其中难治性IDA组有13名（28.9%）患者，治疗后IDA组有5名（5.4%）患者，健康组有1名患者。治疗抵抗性IDA组血清学检测阳性频率显著高于其他两组（P<0.001）。在接受内镜检查和活检的乳糜泻血清学检测阳性患者中，未发现乳糜泻的组织学证据。他们被诊断为潜在乳糜泻。
难治性IDA患者中潜在乳糜泻的发生率高于对照组。因此，我们建议进行血清学筛查以早期发现并减少乳糜泻的并发症，并对该组患者进行反复铁治疗。
