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  • Jefferson Adams
    Jefferson Adams

    Is Celiac Disease Worse in People with Anemia?

    Caption: Photo: CC--Commons

    Celiac.com 09/05/2013 - Current medical science describes diarrhea as a classical symptom of celiac disease, while anemia is described as an atypical or silent manifestation.

    Photo: CC--CommonsHowever, there was actually very little information that accurately compares the severity of celiac disease between patients who present with anemia against those who present with diarrhea.

    A team of researchers recently set out to determine whether people with anemia have more severe celiac disease than people with diarrhea.

    The research team included H.A. Daya, B. Lebwohl, S.K. Lewis, and P.H. Green. They are affiliated with the Celiac Disease Center, Department of Internal Medicine at the Columbia University College of Physicians and Surgeons in New York.

    For their study, the researchers selected a study group of 727 patients from a database of celiac disease patients evaluated at a tertiary referral center between 1990 and 2011. They used the degree of villous atrophy and clinical and serologic parameters to determine the severity of the celiac disease for each patient.

    The team compared patients according to mode of presentation and sex. They also conducted age and sex-adjusted multivariable analyses to assess the association between the mode of celiac disease presentation and cholesterol level, bone density, severity of villous atrophy, erythrocyte sedimentation rate (ESR), and level of anti-tissue transglutaminase (anti-tTG).

    They found that just over three-quarters of the patients presented with diarrhea, while just under one-quarter presented with anemia; 92% of which was iron deficient anemia.

    Multiple regression analysis showed that celiac disease with anemia was associated with lower levels of total cholesterol (P=.02) and high-density lipoprotein (P=.002), and a higher ESR (P=.001) and level of anti-tTG (P=.01).

    In women only, celiac disease with anemia was associated with a lower level of cholesterol.

    Anemic patients were more than twice as likely to have severe villous atrophy and a low bone mass density at time they were diagnosed with celiac disease than were patients who presented with diarrhea.

    So, the results show that celiac disease patients who present with anemia have more severe disease than those who present with diarrhea. There also seem to be sex-specific differences with respect to the connection between anemia and the various features of celiac disease, such as cholesterol.

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    Anemia comes from having celiac disease...of course they were twice as likely the anemia is caused from not absorbing nutrients because you have CELIAC disease! Come on folks...

     

     

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    Guest Desoperate Lady Saved

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    This article compared those who have been diagnosed because they have diarrhea to those that were diagnosed because they have anemia. I had the anemia and think that if one had diarrhea, they couldn't ignore it. I wonder if those with anemia are generally sick longer and that could be the reason they have more malabsorption problems.

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    I had anemia and really bad diarrhea for many years, before my celiac diagnosis. My parents had the same, but were never tested for celiac. We all had low iron and other nutrients on our blood tests.

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    This article compared those who have been diagnosed because they have diarrhea to those that were diagnosed because they have anemia. I had the anemia and think that if one had diarrhea, they couldn't ignore it. I wonder if those with anemia are generally sick longer and that could be the reason they have more malabsorption problems.

    My celiac presented with anemia. I tried to address it myself, with diet, until I was passing out. Then doctors misdiagnosed it for years until the intestinal issues presented. So I think you are correct, plus doctors don't think of celiac when they see anemia.

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    I had anemia and bowel issues when I was diagnosed as well. Although my bone desnisty is good. I was 29 when I was diagnosed, I'm 31 now and my Ttg is still above normal (although it's now in the readable test range, so that's good). And no, after diagnosis I haven't 'cheated'.

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    My GI and hematologist said that since I was diagnosed with celiac at age 51 and most likely had the disease most of my life with no symptoms until severe anemia a few years ago, my iron deficiencies may continue because my small intestine is very damaged and not absorbing well...I have been gluten free 14 months. I have had a series of iron infusions in the past year.....

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    South Med J. 2004;97:30-34 Celiac.com 03/30/2004 – According to Umaprasanna S. Karnam, MD (University of Miami School of Medicine in Florida), and colleagues, celiac disease is present in around 3% of iron-deficiency anemia cases. The researchers looked at all patients seen at the University of Miami for iron-deficiency anemia between 1998 and 2000. Iron-deficiency anemia was defined in their study as serum ferritin less than 25 ng/mL and hemoglobin less than 12 g/dL for women and less than 14 g/dL for men. Interestingly, patients with prior documented ulcerative or erosive conditions of the gastrointestinal tract or overt gastrointestinal bleeding during the prior three months were excluded (which means that many with advanced celiac disease would have been excluded from this study). Out of 139 possible patients with iron-deficiency anemia, 105 patients were included in the study (57 men and 48 women).
    According to the researchers: The prevalence of occult celiac disease in this prospective study of patients presenting with iron-deficiency anemia was 2.8%. A significant number of other gastrointestinal lesions amenable to therapy were also found on upper and lower endoscopy in these patients, the authors write. Given the treatable nature of celiac disease, it should be screened for in patients with unexplained iron-deficiency anemia with or without hemoccult-positive stools. The investigators recommend panendoscopy and screening for this treatable condition in unexplained cases.
    It is likely that had the study included patients with gastrointestinal bleeding or ulcerative conditions the rate of celiac disease would have been higher, perhaps as high as 5%.

    Hallie Davis
    Celiac.com 08/18/2009 - Many of you know that DQ8 is one of the two major genes which may lead to celiac disease. You may also know that celiac disease is often associated with various other autoimmune diseases. What you may not know is that DQ8 may be the direct cause of these other autoimmune diseases, for these autoimmune diseases are found in increased incidence not just in celiac disease, but also with DQ8 itself.
    What follows is a list I have compiled showing the various diseases that are found in increased frequency among people who have the DQ8 gene (DQB1*0302). I will show the reference number next to each, and the corresponding references will appear below:

    Celiac disease (1) Scleroderma (2) Rheumatoid arthritis (1) Autoimmune thyroiditis (3) Pemphigus (4) Lupus (6) Pemphigoid (5) Focal myositis (7) Multiple sclerosis (8) Myasthenia gravis (1) Insulin dependant latent autoimmune diabetes of adults and adult Type 1 diabetes (9) Type 1 juvenile diabetes (1) Sjogren’s syndrome (10) Addisons’s disease (11) Complex regional pain syndrome with dystonia (12) Latex allergy (13)
    This list is not intended to be exhaustive. It is a starter list. Hopefully more research will be done on these, including carefully controlled research as to whether gluten plays any role in triggering these other autoimmune diseases even in the absence of gluten blood antibodies or positive duodenal biopsies. I, for one have DQ8 and numerous of these autoimmune diseases, even though my gluten blood antibodies and duodenal biopsies are negative. We who have this gene need to know for certain #1 whether a gluten free diet will help prevent the triggering of these other various autoimmune diseases, and #2 whether a gluten-free diet will help mitigate autoimmune symptoms that have already developed. I feel no better on the gluten-free diet than before I started it a year and a half ago. However, if I had not been on the diet, perhaps I would be feeling even worse now. Only controlled research will give us the answer.References:

    http://en.wikipedia.org/wiki/HLA-DQ8 Autoantibodies to fibrillarin in systemic sclerosis (scleroderma). An immunogenetic, serologic, and clinical analysis. Frank C. Arnett, MD, John D. Reveille, MDet al. See abstract at http://www3.interscience.wiley.com/journal/112212324/abstract. A strong association between thyrotropin receptor-blocking antibody- positive atrophic autoimmune thyroiditis and HLA-DR8 and HLA-DQB1*0302 in Koreans. Cho, JH Chung, YK Shong, YB Chang, H Han, JB Lee, HK Lee and CS Koh. See abstract at http://jcem.endojournals.org/cgi/content/abstract/77/3/611. Association between HLA-DRB1, DQB1 genes and pemphigus vulgaris in Chinese HansBy Zhou SH, Lin L, Jin PY, Ye SZ. See abstract at: http://www.ncbi.nlm.nih.gov/pubmed/12579512. Polymorphisms of HLA-DR and -DQ Genes in Japanese Patients with Bullous Pemphigoid. By Okazaki A, Miyagawa S, et al. See abstract at: http://sciencelinks.jp/j-east/article/200017/000020001700A0339663.php. HLA-DRB1*03 and DQB1*0302 associations in a subset of patients severely affected with systemic lupus erythematosus from western India. By U Shankarkumar, K Ghosh, S S Badakere, D Mohanty. See abstract at: http://ard.bmj.com/cgi/content/extract/62/1/92. HLA typing in focal myositis. By Kenji Sekiguchi, Fumio Kanda, Kenichi Oishi, Hirotoshi Hamaguchi, Kenichiro Nakazawa, Nobuya Maeda, Hiroyuki Ishihara and Kazuo Chihara. See abstract at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T06-4DB5B4F-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=975695599&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=36883393fca9b990607eeb0d38116c5a. HLA-DRB1*1501, -DQB1*0301, -DQB1*0302, -DQB1*0602, and -DQB1*0603 alleles are associated with more severe disease outcome on MRI in patients with multiple sclerosis. By Zivadinov Robert; Uxa Laura et al. See abstract at: http://www.biomedexperts.com/Abstract.bme/17531857/HLA-DRB1_1501_-DQB1_0301_-DQB1_0302_-DQB1_0602_and_-DQB1_0603_alleles_are_associated_with_more_severe_disease_outcome. Similar Genetic Features and Different Islet Cell Autoantibody Pattern of Latent Autoimmune Diabetes in Adults (LADA) Compared With Adult-Onset Type 1 Diabetes With Rapid ProgressionBy Nóra Hosszúfalusi, MD, PHD, Ágnes Vatay, MD1, et al. See abstract at http://care.diabetesjournals.org/content/26/2/452.full. Specific amino acid residues in the second hypervariable region of HLA- DQA1 and DQB1 chain genes promote the Ro (SS-A)/La (SS- autoantibody responses. ByJD Reveille, MJ Macleod, K Whittington and FC Arnett. See abstract at http://www.jimmunol.org/cgi/content/abstract/146/11/3871. Analysis of extended human leukocyte antigen haplotype association with Addison’s disease in three populations. ByGombos, Hermann, et al. See study at: http://www.eje-online.org/cgi/reprint/157/6/757.pdf. HLA-B62 and HLA-DQ8 are associated with Complex Regional Pain Syndrome with fixed dystonia. By Rooij, Gosso, et al. See study at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0K-4WH0JWP-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c869b6d3a38081820fad17c162b510ba. HLA-DQ8 and the HLA-DQ8-DR4 haplotype are positively associated with the hevein-specific IgE immune response in health care workers with latex allergy. By  Rihs Hans-Peter; Chen Zhiping; Ruëff Franziska; et al. See abstract at: http://www.biomedexperts.com/Abstract.bme/12209103/HLA-DQ8_and_the_HLA-DQ8-DR4_haplotype_are_positively_associated_with_the_hevein-specific_IgE_immune_response_in_health_c


    Jefferson Adams
    07/29/2013 - Rates of celiac disease in Caucasian populations of European origin are pretty well documented, but little is known about its prevalence in non-Caucasians.
    Also, data shows that celiac disease is one likely cause of iron-deficiency anemia, but little is known about how celiac disease might contribute to iron deficiency in Caucasians, and especially non-Caucasians.
    A team of researchers recently looked at for links between celiac disease and iron deficiency in both caucasians and non-caucasians.
    The study team included Joseph A. Murray, Stela McLachlan, Paul C. Adams, John H. Eckfeldt, Chad P. Garner, Chris D. Vulpe, Victor R. Gordeuk, Tricia Brantner, Catherine Leiendecker–Foster, Anthony A. Killeen, Ronald T. Acton, Lisa F. Barcellos, Debbie A. Nickerson, Kenneth B. Beckman, Gordon D. McLaren, and Christine E. McLaren.
    To find individuals with iron deficiency and to determine celiac disease rates, the team assessed samples collected from participants in the Hemochromatosis and Iron Overload Screening study. They looked at blood samples from white men 25 years or older and women 50 years or older who participated in the Hemochromatosis and Iron Overload Screening study.
    Individuals with serum ferritin levels ≤12 μg/L were group as iron deficient, while those with serum ferritin levels >100 μg/L in men and >50 μg/L in women served as a control group.
    The team analyzed all samples for human recombinant tissue transglutaminase immunoglobulin A; positive results were confirmed by an assay for endomysial antibodies.
    The team assessed patients with positive results from both celiac disease tests as having untreated celiac disease. They excluded from analysis all subjects with a positive result from only one of the two tests.
    They analyzed HLA genotypes and frequencies of celiac disease between Caucasians and non-Caucasians with iron deficiency.
    In all, the team found 14 cases of celiac disease among the 567 study subjects (2.5%), and just 1 case of celiac disease among the 1136 control subjects (0.1%; Fisher exact test, P = 1.92 × 10−6). The case of celiac disease in the control group was in a Caucasian control subject. There were no cases of celiac disease found in non-Caucasian controls.
    All 14 of the cases of celiac disease found by the team were in the Caucasian group of 363 (4%). There were no cases of celiac disease in the non-Caucasian group of 204 cases (P = .003).
    Overall, individuals with iron deficiency were 28-times more likely to have celiac disease (95% confidence interval, 3.7–212.8) than were healthy control subjects. Also, and interestingly, 13 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype.
    This study shows that celiac disease is linked with iron deficiency in Caucasians. In fact, among Caucasians, celiac disease is rare among individuals without iron deficiency.
    It also shows that celiac disease is rare among non-Caucasians—even among individuals with common features of celiac disease, such as iron deficiency.
    The study team recommends that doctors conduct celiac screening on men and postmenopausal women with iron deficiency.
    Source:
    Clinical Gastroenterology and Hepatology. Volume 11, Issue 7 , Pages 808-814, July 2013

    Jefferson Adams
    Celiac.com 06/09/2014 - Anemia is extremely common in patients with celiac disease. In some cases, anemia may be the sole manifestation of celiac disease, but there is no good data on rates of celiac disease in Indian patients with nutritional anemia. A research team recently examined rates of celiac disease among nutritional anemia patients at a care center in India. The team included A. Kavimandan, M. Sharma, A.K. Verma, P. Das, P. Mishra, S. Sinha, A. Mohan, V. Sreenivas, S. Datta Gupta, and G.K. Makharia.
    For their study, the team conducted positive celiac disease screens on adolescent and adult patients presenting with nutritional anemia. They also prospectively screened for celiac disease using IgA anti-tissue transglutaminase antibody (anti-tTG Ab). Subjects with positive antibody screens received upper gastrointestinal endoscopy and duodenal biopsy.
    In all, the team screened ninety-six patients. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were receiving hematinics and 36.4 % had received blood transfusions. Nineteen patients had histories of chronic diarrhea persisting for an average of about ten years. Of those, the team found 13 patients with positive IgA anti-tTG Ab screens, 12 of whom agreed to duodenal biopsy.
    Ten patients showed villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six), while two patients showed no villous atrophy. In all, ten patients with nutritional anemia, defined as iron deficiency 9, vitamin B12 deficiency 1, were also diagnosed with celiac disease.
    Multivariate logistic regression showed age, duration of symptoms, and presence of diarrhea to be the main predictors of celiac disease. The team put all patients with celiac disease on gluten-free diet, supplemented with iron and vitamin B. All patients showed significant improvement in hemoglobin concentration.
    The team recommends celiac disease screening, and appropriate follow-up in all cases of unexplained nutritional anemia.
    Source:
    Indian J Gastroenterol. 2014 Mar;33(2):114-8. doi: 10.1007/s12664-013-0366-6. Epub 2013 Sep 1.

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    And he needs to be super strict in his gluten free diet! SUPER strict, not just low gluten. No cross contamination, NONE.  I am so sorry, there are no short cuts with the testing. It flat out sucks but there you have it.  Welcome to the forum!
    Hi TDZ, My understanding is the same, a full gluten challenge is needed for the DH diagnosis.  The method the use for DH is to take a skin biopsy from next to a lesion, not on it.  They check the biopsy for IgA antibodies. I don't know of any way to shortcut the process and avoid eating gluten to get tested.  There may be a test some  day that doesn't require it, but for now I don't think there are any out there. One thing he might not have tried is avoiding iodine.  Some of the m
    Hello, new here and new to the whole thing! My husband has been battling this rash and assorted digestive issues for years. He was diagnosed with contact dermatitis by the dermatologist, had some steroid injections and various creams over the last couple of years, and then in November he went to the ER and they said eczema and gave him steroid pills. This was after a huge bloom that pretty much hit him from head to toe, where it had been mostly arms and legs before. He finally concluded he
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