Odhaib Samih Abed, Mohammed Miaad Jassim, Hamadi Saad Shaheen
Iraqi Board of Medical Specialization, American College of Physicians, Faihaa Teaching Hospital-Basrah-Iraq, Faihaa Specialized Diabetes Endocrine and Metabolism Center, Basrah, Iraq.
Arab Board of Health Specialization (Radiology). Al-Refaee General Hospital. Thi-Qar Health Directorate, Thi Qar, Iraq.
Med J Islam Repub Iran. 2022 Mar 12;36:20. doi: 10.47176/mjiri.36.20. eCollection 2022.
The classic celiac disease (CD) presentation in individuals with iron deficiency anemia (IDA) has been changed given the large percentage of subtle or asymptomatic cases. The study objective was to assess the predictive factors influencing the diagnosis and severity of villous atrophy in individuals with CD and IDA referred for a diagnostic endoscopy. This was a retrospective observational, cross-sectional analysis of the medical records of 499 individuals with IDA in 2 centers in Basrah, Iraq, who referred for possible diagnosis of CD within 10 years (2006-2016). The relationship of the severity of anemia, demographic characteristics, symptomatology, and celiac serological results on the final diagnostic endoscopic evaluation was evaluated using a univariate analysis, at a P value ≤ 0.05. The study adopted the Marsh classification for celiac disease diagnosis where Marsh type 3 represents the definite celiac disease. The definite diagnosis was seen in 44.5% of the cohort (n = 222), with asymptomatic cases representing 22.5% of cases (n = 50). The mean age was (27 ± 11) years, with significant association to (female gender, age ≤45 years, positive celiac serology, and severity of anemia). After adjustment of the variables, the Marsh type was significantly correlated with positive celiac serology, low hemoglobin, and presence of gastrointestinal symptoms. The positive celiac serology, low hemoglobin <9 g/L, and the presence of gastrointestinal symptoms are strong predictors of the severity of villous atrophy (Marsh type).
鉴于缺铁性贫血（IDA）患者中存在大量症状轻微或无症状的乳糜泻（CD）病例，其典型临床表现已发生改变。本研究的目的是评估影响因诊断性内镜检查而转诊的CD合并IDA患者绒毛萎缩诊断及严重程度的预测因素。这是一项对伊拉克巴士拉两个中心499例IDA患者的病历进行的回顾性观察性横断面分析，这些患者在10年（2006 - 2016年）内因可能的CD诊断而转诊。使用单因素分析评估贫血严重程度、人口统计学特征、症状学和乳糜泻血清学结果与最终诊断性内镜评估之间的关系，P值≤0.05。本研究采用马什分类法诊断乳糜泻，其中马什3型代表确诊的乳糜泻。该队列中44.5%（n = 222）被确诊，无症状病例占病例总数的22.5%（n = 50）。平均年龄为（27±11）岁，与（女性、年龄≤45岁、乳糜泻血清学阳性和贫血严重程度）显著相关。在对变量进行调整后，马什类型与乳糜泻血清学阳性、低血红蛋白和胃肠道症状的存在显著相关。乳糜泻血清学阳性、血红蛋白<9 g/L以及胃肠道症状的存在是绒毛萎缩严重程度（马什类型）的有力预测指标。
