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Celiac.com 09/04/2024 - Researchers conducted a retrospective, observational cohort study with the aim of determining whether iron deficiency at the time of celiac disease diagnosis affects the tissue transglutaminase antibody (TTG) normalization rate among pediatric patients on a gluten-free diet. Celiac disease is an immune-mediated disorder triggered by gluten consumption in genetically predisposed individuals, often diagnosed using specific serological tests. A gluten-free diet is the only effective treatment, and the study investigates whether iron deficiency affects the rate of antibody normalization in pediatric patients adhering to this diet. Methods The researchers conducted a retrospective, observational cohort study involving children aged 2-18 years diagnosed with celiac disease between January 2016 and December 2020. Data on demographics, hemoglobin, ferritin, and antibody levels were collected at diagnosis and one year after starting a gluten-free diet. Iron deficiency was defined by specific hemoglobin and ferritin levels. The primary focus was to compare tissue transglutaminase antibody normalization rates between children with and without iron deficiency at diagnosis. Results The study included 118 pediatric patients. At diagnosis, 51.7% had iron deficiency, with a higher prevalence among females in the non-iron deficient group. The median age at diagnosis was slightly lower for those with iron deficiency. After one year on a gluten-free diet, 65.5% of children with iron deficiency achieved antibody normalization, compared to 53.8% of those without iron deficiency, though this difference was not statistically significant. Notably, male children had a significantly higher rate of antibody normalization than females. Discussion The study's findings indicate that iron deficiency at the time of celiac disease diagnosis does not significantly impact the rate of antibody normalization after one year on a gluten-free diet. However, male children showed a higher likelihood of achieving normalization compared to females. This gender disparity suggests that other factors might influence antibody normalization rates, warranting further research. The study's results align with previous research showing no significant difference in serological response between children with and without anemia at diagnosis. Conclusion The study concludes that iron deficiency at diagnosis does not hinder tissue transglutaminase antibody normalization in pediatric celiac disease patients adhering to a gluten-free diet. The observed higher normalization rates among males suggest that gender-specific factors may influence the immune response to a gluten-free diet. Future research should focus on understanding these factors and their implications for managing celiac disease in children. Significance for Celiac Disease Patients For individuals with celiac disease, this study provides valuable insights into the role of iron deficiency in disease management. It reassures parents and healthcare providers that iron deficiency at diagnosis does not delay antibody normalization, highlighting the importance of maintaining a gluten-free diet. Additionally, the gender-specific findings may guide personalized treatment approaches, improving outcomes for children with celiac disease. This study underscores the need for ongoing research to optimize care for pediatric celiac disease patients. Read more at: cureus.com

Celiac.com 08/11/2023 - Celiac disease is a chronic autoimmune disorder marked by an immune-mediated response to gluten, resulting in small intestinal mucosal damage. Every so often, we share reports of individual cases that are relevant to celiac disease. Here, we share the case of a 52-year-old woman who was discovered to have celiac disease after being treated for extreme thrombocytosis and severe anemia. While gastrointestinal symptoms are commonly associated with celiac disease, atypical presentations can pose diagnostic challenges, particularly when hematological abnormalities are the primary manifestation. A team of clinicians report the case of a 52-year-old female patient who presented with unusual symptoms, including numbness in her hands and feet, extreme thrombocytosis, extreme thinness, severe anemia, high platelet count, and mild electrolyte imbalance. The Research Team The clinical team included Cuauhtemoc Jeffrey Soto, Lokeshwar Raaju Addi Palle, Mefthe Berhanu, Yordanos G. Negassi, Saima Batool, and Shaniah S. Holder. They are variously affiliated with the department of Research and Development at the Universidad Juarez del Estado de Durango, Mexico, the department of General Surgery, Hackensack Meridian Health-Palisades Medical Center, North Bergen, USA; the Department of Surgery, Kamala Children's Hospital in Chennai, India; the Health Science Department, University of Texas Health Science Center at Houston, Texas, USA; the department of Internal Medicine, Orotta, California, USA; the department of Internal Medicine, Hameed Latif Hospital in Lahore, Pakistan; and the department of Medicine, American University of Barbados School of Medicine in Bridgetown, Barbados. Physical examination of the patient showed nothing remarkable, except for notable thinness. The patient showed no gastrointestinal symptoms, and had no family history of gastroenterological diseases. Diagnostic tests, including blood tests and duodenal biopsy, confirmed the diagnosis of celiac disease with grade 4 Marsh 3C classification, even though the patient lacked typical gastrointestinal symptoms. Celiac Disease as a Cause of Thrombosis This case highlights the importance of considering celiac disease as a potential cause for atypical hematological manifestations, such as extreme thrombocytosis resulting from severe anemia. Prompt recognition and appropriate management, such as adhering to a gluten-free diet, can lead to symptom improvement and the resolution of hematological abnormalities. Identifying celiac disease even in the absence of typical gastrointestinal symptoms can lead to important treatment and improved quality of life for patients. Healthcare professionals need to be aware of such atypical presentations to ensure early diagnosis and better patient outcomes. Read more at cureus.com

Celiac.com 10/22/2022 - Close to one quarter of the world’s population, in both industrialized and developing countries, suffer from iron deficiency and/or iron deficiency anemia. Although it is a widespread problem, those who are gluten sensitive should be particularly careful to monitor their iron status regularly. Iron deficiency is not only an important sign of undiagnosed celiac disease, it may also reflect some degree of intestinal damage—and most of our iron is absorbed in the same part of the intestine as calcium. The jejunum is the site of most of the damage caused by gluten, which may explain the significant overlap between gluten sensitivity and iron deficiency anemia. The two primary causes of iron deficiency are either inadequate absorption of iron or excessive blood loss, and intestinal bleeding is common among the gluten sensitive. Iron deficiency can also result from vitamin A deficiency, which can also be a feature of celiac disease. Several years after I began following a gluten-free diet, a blood test that was part of a regular physical exam revealed that I was mildly anemic. By now you may be wondering, just as I did, what the difference is between iron deficiency and iron deficiency anemia. Simply put, iron deficiency anemia is where the hemoglobin content of one’s blood is below normal. This means that there are fewer blood cells that carry oxygen to be distributed throughout the body. My greatest concern with my own inclination to anemia, both before and after diagnosis, is that iron deficiency can impair memory and reduce learning acuity. Most of this impact occurs prior to the development of anemia. Iron deficiency first depletes iron stores in a wide range of tissues and organs before it causes significant losses to hemoglobin. Iron is needed to make several neurotransmitters including dopamine, serotonin, and norepinepherine. These neurotransmitters are involved in a wide range of brain activities related to alertness, attention, remembering, learning, and a variety of other brain functions. Some researchers at the University of Maryland have reported that iron deficient adolescent girls show a significant improvement in IQ test scores after only 8 weeks of taking iron supplements. There are many other symptoms of iron deficiency, including shortness of breath, light-headedness, lethargy, and pale skin. However, it is important not to just rush out and start taking iron supplements. Iron overdose can cause damage to the liver, the heart, or the pancreas. The body must maintain an exquisitely careful balance for optimal health. Further, a significant number of celiacs also suffer from hereditary hemochromatosis which is a condition in which the body is overly thrifty, storing too much iron. Supplementing iron in such a case could have some very serious consequences. Regular testing is an important strategy. Iron deficiency or anemia is more likely to be ignored or to be given less attention simply because of the frequency with which it occurs. However, it is a particularly important issue to those who are gluten sensitive, if only from a quality-of-life perspective. Even if peace of mind is the only result of getting regular check-ups that include a complete blood count, our reward is large. Similarly, early detection and reversal of iron deficiency before it causes memory disturbances and other unwanted symptoms, or before it goes on to develop into anemia, could be a huge dividend to collect from paying careful attention to our iron levels.

Celiac.com 09/03/2022 - Anemia is one of the most common presentations in adults with newly diagnosed celiac disease. In 1996 approximately 3.4 million Americans were diagnosed with anemia, according to the Centers for Disease Control, and out of these 2.1 million were under the age of 45. Celiac disease can present with classic and/or atypical symptoms. Atypical symptoms of celiac disease are associated with malabsorption and can include iron deficiency anemia in both adults and children. Celiac disease was once thought to be a childhood disease. However the average age at diagnosis today is 40 to 50 years old. It is more commonly seen in women than men. Celiac disease is a disease that can begin in infancy with gastrointestinal symptoms, in childhood, or even late in life. Many persons diagnosed later in life may have no gastrointestinal symptoms. Often, in older adults, routine health checks discover silent celiac disease, because of undefined anemia or bone disease(3). Anemia can be a symptom of many conditions, including excess blood loss from bleeding or surgery; autoimmune diseases such as celiac disease; chronic infections, or from the use of some medications. There are different types of anemia. Blood studies are used to help determine the type of anemia, its possible cause, and the correct treatment. Macrocytic anemia is usually caused by a folate or vitamin B12 deficiency. Microcytic anemia is a caused from iron deficiency. Inflammation, either chronic or acute, can alter ferritin levels in persons with iron-deficiency anemia. When inflammation is present, iron levels can appear either normal or elevated in iron deficiency. Folate deficiency should be considered in persons who have both celiac disease and anemia. Folate is absorbed in the jejunum, the upper part of the small intestine. This is the part of the small intestine that is largely damaged in untreated or undiagnosed celiac disease. Celiac disease is a disease of malabsorption due to inflammation and damage of the microvilli and villi of the small intestine. The microvilli and villi normally increase the absorption capacity of the small intestine by expanding its surface area to nearly 500 times its length. When there is damage to the jejunum and duodenum, the absorption of many nutrients, including iron, is altered. Celiac disease is not often suspected when a person is diagnosed with persistent anemia that does not respond well to traditional therapies, even though iron absorption can be significantly altered by the damage to the intestine. Studies suggest that persons with celiac disease may present with anemia as a single symptom or one of many symptoms. The incidence of anemia in the patients with newly diagnosed celiac disease ranges from 4% in the United States, to 24% in Romania, and over 66% in East Indian patients. In surveys of members of national celiac support groups in Canada and the U.S., anemia is a common pre-celiac diagnosis. Three recent studies in the United Kingdom screened men and women with anemia for celiac disease and found undiagnosed celiac disease in 2.3 to 6.7 percent of subjects. Another study in the UK screened 1,200 people in the general population and found celiac disease in one percent, a frequency similar to that of the U.S. study. It is possible to conservatively estimate that 78,000 people with anemia in the US could have celiac disease as the cause of their anemia. Clearly, physicians treating patients with anemia should consider screening them for celiac disease, especially if the anemia is unresponsive to traditional therapy. Anemias Found in Celiac Disease Several conditions can contribute to the development of anemia, including blood loss, poor diet, genetic disorders, chronic illnesses, and damage to the bone marrow from radiation or chemotherapy. Gastrointestinal conditions, such as Crohn’s disease or celiac disease, that decrease the absorption of iron, folate, or vitamin B12 can also cause anemia. Iron-deficiency anemia is the most common type of anemia found in women. The most common causes of iron-deficiency anemia are blood loss due to menstruation or pregnancy, and poor absorption of iron from foods(15). Iron deficiency is uncommon in postmenopausal women. If iron-deficiency anemia is discovered in postmenopausal women, it is generally the result of bleeding in the gastrointestinal tract or malabsorption. Both iron-deficiency anemia and B12 deficiencies are common in celiac disease. Iron-deficiency anemia is the most common type of anemia found with celiac disease. Decreased iron and folate absorption are often seen in untreated celiac disease. Many physicians overlook iron and folate malabsorption as a cause of anemia. As part of the evaluation process for iron-deficiency anemia endoscopic procedures are often performed, generally without taking biopsies of the small intestine. If biopsies are not taken, celiac disease would be overlooked as the causal factor for the anemia. Anemia generally develops slowly with symptoms worsening over time. Common symptoms of anemia include extreme fatigue, pale skin, weakness, shortness of breath, lightheadedness, and cold hands and feet. Iron-deficiency anemia symptoms may also include with cracks at the sides of the mouth, complaints of inflamed or sore tongue, brittle nails, pica, headaches, decreased appetite, and increased infections. Some people may also experience Restless Leg Syndrome. If not treated, iron-deficiency anemia can lead to other severe health problems, such as heart irregularities; complications with premature and low-birth-weight infants; and delayed growth and development in children. Symptoms of Vitamin B12 deficiency can cause yellowing or darkening of the skin, colorblindness to yellow-blue colors, and confusion or forgetfulness. Signs of vitamin B12 deficiencies such as neurological problems, peripheral neuropathy, mental confusion and forgetfulness can be seen before anemia is diagnosed. The most likely cause of vitamin B12 deficiency in celiac disease is due to damage in the small intestine, which makes it difficult to adequately absorb B12. Bacterial overgrowth in the small intestine is another possible cause of B12 deficiency. Anemia, as a result of vitamin B12 deficiency is considered to be uncommon in celiac disease that is diagnosed early. In a small study of 39 patients, Dahele, et al., 16 (41 percent) were found to have vitamin B12 deficiency and 16 were anemic. After four months on a gluten-free diet all patients with B12 deficiency had B12 levels that normalized. Only five patients with combined folate and B12 deficiencies received B12 therapy. Dickey found in screening celiac patients with low serum vitamin B12 levels that low B12 is common in celiac disease without having pernicious anemia, and may be the only presenting manifestation of celiac disease (14). Studies by Dahele and Dickey suggest that vitamin B12 deficiency is a common condition in untreated celiac disease, however their studies do not support that pernicious anemia is associated with celiac disease. Dahele and Dickey indicate the vitamin B12 deficiency usually resolves on a gluten-free diet, without vitamin B12 replacement. Treating Anemia in Celiac Disease The most important issue in anemia as a result of celiac disease is to follow strict gluten-free diet. The small intestine must heal in order to absorb nutrients correctly and adequately. Studies indicate that it can take several months to years to heal the small intestine in persons with celiac disease, and it is imperative that all persons with celiac disease have regular follow-up visits with a dietitian to check the adequacy of their diet. A gluten-free diet alone has been shown to reverse signs of anemia in most newly diagnosed celiac patients. In otherwise healthy individuals, it takes six to 12 months of diet therapy to correct anemia. Reversing anemia in persons with celiac disease may take several months longer, even with supplementation. Iron replacement therapy may not be necessary in mildly-depleted persons. In these cases a gluten-free diet high in iron-rich foods and a good gluten-free multi-vitamin supplement should be tried for six to 12 months before further therapy options are considered. Persons taking iron supplements should take iron with vitamin C-rich foods, such as citrus juice, which will help increase iron absorption. They should also avoiding calcium and dairy products within an hour of eating iron-rich foods, as calcium binds with iron and neither nutrient is absorbed well. Iron-rich foods including fish, poultry, and red meats should be included at each meal. Use of coffee and tea should be restricted. Iron supplementation therapy recommendations for persons with celiac disease vary by physician. Recommendations of up to one gram of iron per day, with close monitoring for clinical and blood level improvement are sometimes recommended. In severe situations, blood transfusions are used to boost the patient’s initial iron and hemoglobin levels. As with other medications, all supplements used must be gluten-free. Foods rich in iron that are naturally gluten-free include: lean red meats, liver, kidney, clams, oysters, shrimp, chicken, haddock, crab, tuna, salmon, turkey, broccoli, parsley, leafy greens, peas, dried beans, lentils, peaches, pears, dates, raisins, dried prunes, and blackstrap molasses. Many of the special seeds and flours used in the gluten-free diet are rich in iron, including amaranth, buckwheat, Montina™, quinoa, and teff. These foods are also high in other nutrients, including calcium, amino acids, magnesium, zinc and fiber. When compared to whole wheat and enriched all-purpose white wheat flours (iron content 4.7 mg and 5.8 mg, respectively), many of the gluten-free flours are nutritionally equal or superior to wheat flour. Amaranth, buckwheat, flax, garfava, millet, Montina™, quinoa, rice bran and soy all have higher iron content than wheat flours. In gluten-free baking, a blend of flours is required for best results. Many of the flours mentioned above are used as secondary ingredients in the flour blends, in combination with refined starches such as rice flour, potato starch and tapioca or corn starch, all of which are much lower in iron than wheat flour. Using the whole seed or groat of these seeds in cooking can significantly increase the iron content of the gluten-free diet. Many of these products make wonderful side-dishes and starches in casseroles or soups. Teff is used as a staple food in Ethiopia. It is extremely high in iron and it is speculated that it is the extensive use of teff that keeps the incidence of iron-deficiency anemia low in Ethiopia. For persons with celiac disease who are also lactose intolerant or choose to follow a vegetarian diet, inclusion of these seeds helps to assure adequate nutrient intake. Anemia is common in the general population and even higher in celiac disease. Malabsorption is a common cause of anemia. Persons with anemia are at risk for celiac disease. Patients with anemia from unknown reasons or those who do not respond to traditional treatments require further evaluation which should include screening for celiac disease. If celiac disease is discovered, appropriate treatment with a gluten-free diet that includes foods that are rich in iron is normally all that is necessary to treat anemia in most cases. The Dietary Reference Index (RDI) for Iron: 7 to 10 mg/day for young children 8 to 11 mg/day for males 15 to 18 mg/day for females of menstrual age 8 mg/day for older females 27 mg/day during pregnancy References: Anemia, Vital and Health Statistics, Series 10, No. 200 , 1996. <http://www.cdc.gov/nchs/fastats/anemia.htm> Accessed 9/10/03 Fasano A, Berti I, et al. Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States Arch Intern Med. 2003;163:286-292. Guandalini S. Celiac disease. School Nurse News. 2003 Mar;20(2):24-7. Sood A, Midha V, et al. Adult celiac disease in northern India. Indian J Gastroenterol. 2003 Jul-Aug;22(4):124-6. Sachdev A, Srinivasan V, et al. Adult onset celiac disease in north India. Trop Gastroenterol. 2002 Jul-Sep;23(3):117-9. Dobru D, Pascu O, et al. The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (a multicentre study). Rom J Gastroenterol. 2003 Jun;12(2):97-100. Zipser RD, Patel S, et al. Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci. 2003 Apr;48(4):761-4. Cranney A, Zarkadas M, et al. The Canadian celiac health survey – the Ottawa chapter pilot. BMC Gastroenterol. 2003; 3 (1): 8. Ransford RA, Hayes M, et al. A controlled, prospective screening study of celiac disease presenting as iron deficiency anemia. J Clin Gastroenterol. 2002 Sep;35(3):228-33. Howard MR, Turnbull AJ, et al. A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency. J Clin Pathol. 2002 Oct;55(10):754-7. Brooklyn TN, Di Mambro AJ, et al. Patients over 45 years with iron deficiency require investigation. Eur J Gastroenterol Hepatol. 2003 May;15(5):535-8. Sanders DS, Patel D, et al. A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol. 2003 Apr;15(4):407-13. Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol. 2001 Mar;96(3):745-50. Dickey W. Low serum vitamin B12 is common in coeliac disease and is not due to autoimmune gastritis. Eur J Gastroenterol Hepatol. 2002 Apr;14(4):425-7. Iron-deficiency anemia in women. Harvard Women's Health Watch, Nov 2002, Vol. 10 Issue 3, p3 Anemia Patient Education Sheets. Mayo Clinic website. www.mayoclinic.org. Accessed 9-5-03. Annibale B, Severi C, et al. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol. 2001 Jan;96(1):132-7.

Celiac.com 09/30/2021 - Anemia is common in children with celiac disease, but the details of how the disease develops in the gut remain obscure. One possible explanation could be an abnormal expression of duodenal iron transport proteins. However, the results have so far been unclear. To get a better understanding of the issue, a team of researchers recently set out to compare immunohistochemical stainings of duodenal cytochrome B (DCYTB), divalent metal transporter 1 (DMT1), ferroportin, hephaestin and transferrin receptor 1 (TfR1) in duodenal biopsies between 27 children with celiac disease and duodenal atrophy, 10 celiac autoantibody-positive children with potential celiac disease and six autoantibody-negative control children. The team looked at data for forty-three subjects, twenty-three with anemia, and twenty without. For both groups, the team evaluated expressions of iron proteins with respect to saturation and amount of stained area or stained membrane length of the enterocytes. The team's results showed an increase in the stained area of ferroportin, and a decrease in the saturation of hephaestin, in celiac patients versus control subjects. Meanwhile, the team found no differences in the expression of transporter protein between anemic and non-anemic patients. The present results indicate a change in ferroportin and hephaestin proteins in children with histologically confirmed celiac disease that is independent of iron status. Being able to spot celiac disease in children using simple stain reactions could be helpful to improving early diagnosis of celiac disease. Read more at mdpi.com. The research team included Marleena Repo, Markus Hannula, Juha Taavela, Jari Hyttinen, Jorma Isola, Pauliina Hiltunen, Alina Popp, Katri Kaukinen, Kalle Kurppa, and Katri Lindfors, and Isabel Comino. They are variously affiliated with the Tampere Centre for Child Health Research, Tampere University and Tampere University Hospital in Tampere, Finland; the Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; the Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University in Tampere, Finland; the Central Finland Central Hospital in Jyväskylä, Finland; the Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Tampere University in Tampere, Finland; Jilab Inc., in Tampere, Finland; the National Institute for Mother and Child Health, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; and the Department of Pediatrics, Seinäjoki Central Hospital and University Consortium in Seinäjoki, Finland

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.

Celiac.com 10/17/2017 - Are primary care physicians under-testing for celiac disease in patients with iron deficiency anemia? A new survey of primary care doctors indicates that they are. It's fairly common for people with celiac disease to develop iron deficiency anemia (IDA), but researchers don't know much about the frequency with which primary care physicians test for celiac disease in patients with IDA. A team of researchers recently set out to describe how primary care doctors approach testing for celiac disease in asymptomatic patients with IDA. The research team included Marisa Spencer, Adrienne Lenhart, Jason Baker, Joseph Dickens, Arlene Weissman, Andrew J. Read, Seema Saini, and Sameer D. Saini. They are variously affiliated with the Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America; the Department of Internal Medicine, Henry Ford Health System, in Detroit, Michigan, United States of America; the Department of Statistics, University of Michigan, Ann Arbor, Michigan, United States of America; the Research Center at the American College of Physicians, in Philadelphia, Pennsylvania, United States of America; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America, Ambulatory Care, Veterans Affairs Medical Center, Ann Arbor, Michigan, United States of America. For their study, the team began by electronically distributing a survey to primary care doctors who are members of the American College of Physicians. The survey asked whether doctors would test for celiac disease, either by serologic testing, referral for esophagogastroduodenoscopy [EGD], or referral to GI) in hypothetical patients with new IDA, including: (1) a young Caucasian man, (2) a premenopausal Caucasian woman, (3) an elderly Caucasian man, and (4) a young African American man. The team chose the scenarios to assess differences in testing for celiac disease based on age, gender, and race. They used multivariable logistic regression to identify independent predictors of testing. Testing for celiac disease varied significantly according to patient characteristics, with young Caucasian men being the most frequently tested (61% of respondents reporting they would perform serologic testing in this subgroup (p Interestingly 80% of doctors surveyed said they would definitely or probably start a patient with positive serologies for celiac disease on a gluten-free diet prior to confirmatory upper endoscopy, which is contrary to guideline recommendations. This survey indicates that primary care doctors are under-testing for celiac disease in patients with IDA, regardless of age, gender, race, or post-menopausal status. The majority of primary care doctors surveyed do not strictly adhere to established guidelines regarding a confirmatory duodenal biopsy in a patient with positive serology for celiac disease. Clearly, even with all of the advances in celiac disease awareness and with more refined protocols, primary care doctors have some work to do when it comes to testing IDA patients for celiac disease, and even more work to do in following proper referral guidelines before putting patients on a gluten-free diet. Source: PLOSONE

Celiac.com 03/07/2018 - People with celiac disease can sometimes have hematological issues, including chronic anemia. It might be surprising to hear, but aplastic anemia and celiac disease share a similar underlying autoimmune process, but doctors haven't reported many cases that indicate that the two are connected. In fact, medical literature reveals only three pediatric cases indicating a connection. Recently, clinicians reported the first case in a female pediatric patient. The clinical team included Omar Irfan, Sana Mahmood, Heera Nand, and Gaffar Billoo, with the Medical College and the Department of Pediatrics at Aga Khan University Hospital in Karachi, Pakistan. Their team treated a 6-year-old South Asian girl who had bruises, petechiae, and recent history of loose stools. On evaluation, the team diagnosed the girl to have celiac disease and prescribed a gluten-free diet. Follow-up assessment including bone marrow biopsy showed the girl to have pancytopenia. The team managed the girl's condition with packed red cells, platelets, and diet restrictions, and the girl showed improving platelet counts over yearly follow up visits. Eventually, the girl will need a bone marrow transplant, and the team spoke about that to the girl's parents. This is now the fourth report indicating a connection between celiac disease and aplastic anemia in children, and the clinical team wonders if the connection might be more common than is currently understood. Timely treatment of celiac disease through strict gluten-free diet, or aplastic anemia through immunosuppressive therapy, could help reduce the development of other autoimmune conditions. Because all four pediatric cases reporting potential celiac disease/aplastic anemia association occurred in South East Asia, the authors suggest larger studies to explore this connection. Source: J Med Case Reports. 2018;12(16)