Aim
Celiac disease (CD) is a well-known cause of iron deficiency anaemia (IDA). IDA may represent the sole clinical manifestation of celiac disease, especially in patients with subclinical or atypical forms of celiac disease. Histological examination is the cornerstone in reaching the diagnosis. Our study aimed to evaluate the role of duodenal biopsies taken in diagnosing CD in patients presenting with iron deficiency anaemia of unknown origin (IDA) and to examine the prevalence of CD in patients with IDA of unknown origin.
Methods
Between June 2019 and December 2022, 248 consecutive patients over the age of 18 who underwent duodenal biopsy during the esophagogastroduodenoscopy (EGD) procedure as part of the evaluation of iron deficiency anaemia of unknown origin in our endoscopy unit were included in the study. The prevalence of celiac disease was evaluated retrospectively. Anti-endomysial antibody (EMA) and tissue transglutaminase antibody (tTG) levels of patients with abnormal duodenal histology were assessed. A positive serological test and abnormal duodenal histology made the diagnosis of CD. Histopathological changes were evaluated according to the Marsh classification.
Results
A total of 248 patients (171 women) who met the study criteria were included. Celiac disease was detected in 8 (3.2%) patients whose duodenum biopsy was taken. The mean age of celiac patients was 36±14 years. The female-to-male ratio was found to be 3:1. Histopathology revealed Marsh III in 5 (62.5%) patients, Marsh II in 2 (25%), and Marsh I and lesions in 1 (12.5%). All patients who showed pathological changes in duodenal biopsy (Marsh I, II & III) had positive serology. There was no significant difference in mean haemoglobin, MCV and ferritin levels between patients with and without celiac disease with iron deficiency anaemia.
Conclusion
Routine duodenal biopsies taken during the upper endoscopic examination of IDA patients provide a diagnostic benefit of 3.2% in CD. Therefore, this practice should be systematically included in the diagnostic studies of patients with IDA, even if the endoscopic appearance of the mucosa is normal.
Key words: coeliac disease, iron deficiency anemia, duadenal biopsy
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