Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Uppsala, Sweden.
Gastroenterology. 2018 Aug;155(2):374-382.e1. doi: 10.1053/j.gastro.2018.04.016. Epub 2018 Apr 22.
BACKGROUND & AIMS: Anemia is common in patients with celiac disease (CD) and a frequent mode of presentation. Guidelines recommend screening patients with iron-deficiency anemia (IDA) for CD. However, the reported prevalence of CD in patients with IDA varies. We performed a systematic review to determine the prevalence of biopsy-verified CD in patients with IDA.
We performed a systematic review of articles published in PubMed Medline or EMBASE through July 2017 for the term "celiac disease" combined with "anemia" or "iron deficiency." We used fixed-effects inverse variance-weighted models to measure the pooled prevalence of CD. Meta-regression was used to assess subgroup heterogeneity.
We identified 18 studies composed of 2998 patients with IDA for inclusion in our analysis. Studies originated from the United Kingdom, United States, Italy, Turkey, Iran, and Israel. The crude unweighted prevalence of CD was 4.8% (n = 143). Using a weighted pooled analysis, we found a prevalence of biopsy-confirmed CD of 3.2% (95% confidence interval = 2.6-3.9) in patients with IDA. However, heterogeneity was high (I = 67.7%). The prevalence of CD was not significantly higher in studies with a mean participant age older or younger than 18 years or in studies with a mixed-sex vs female-predominant (≥60%) population. On meta-regression, year of publication, female proportion, age at CD testing, and prevalence in the general population were not associated with the prevalence of CD in patients with IDA. In the 8 studies fulfilling all our quality criteria, the pooled prevalence of CD was 5.5% (95% confidence interval = 4.1-6.9).
In a systematic review and meta-analysis, we found that approximately 1 in 31 patients with IDA have histologic evidence of CD. This prevalence value justifies the practice of testing patients with IDA for CD.
缺铁性贫血（IDA）是乳糜泻（CD）患者的常见表现，也是其常见发病模式。指南建议对缺铁性贫血患者进行 CD 筛查。然而，IDA 患者 CD 的报道患病率差异较大。本研究旨在通过系统评价确定 IDA 患者 CD 的活检确诊率。
检索 2017 年 7 月前在 PubMed Medline 或 EMBASE 中发表的有关“乳糜泻”和“贫血”或“缺铁”的文章，采用固定效应逆方差加权模型测量 CD 的汇总患病率。采用元回归评估亚组异质性。
纳入了 18 项研究共 2998 例 IDA 患者，CD 粗患病率为 4.8%（n=143）。采用加权汇总分析发现，IDA 患者活检确诊 CD 的患病率为 3.2%（95%置信区间=2.6%-3.9%），但异质性较高（I=67.7%）。参与者平均年龄>18 岁或<18 岁、男女混合或女性（≥60%）为主的研究中 CD 患病率无显著差异。Meta 回归分析显示，发表年份、女性比例、CD 检测年龄和普通人群中的患病率与 IDA 患者的 CD 患病率无关。满足所有质量标准的 8 项研究中，CD 的汇总患病率为 5.5%（95%置信区间=4.1%-6.9%）。
在系统评价和荟萃分析中，IDA 患者中有组织学证据的 CD 患病率约为 1/31。这一患病率值支持对 IDA 患者进行 CD 检测的做法。
