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Jefferson Adams posted an article in Anemia and Celiac DiseaseCeliac.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.
Diana Gitig Ph.D. posted an article in Infertility, Impotency and Celiac DiseaseCeliac.com 12/20/2011 - There has been some controversy surrounding the idea that there is a higher prevalence of undiagnosed celiac disease in people with infertility, with some studies finding it but others not. Most of these studies have been performed in Europe; only two to date have taken place in the United States. Peter Green’s group at Columbia recently tried to establish the actual prevalence of undiagnosed celiac disease in the infertile population in the United States, to determine if it would make sense to routinely screen a subgroup of infertile patients for celiac disease. Their results are published in The Journal of Reproductive Medicine. Study participants were recruited from the population who came to Columbia’s Center for Women’s Reproductive Care to deal with their infertility issues, which they had been coping with for at least a year. One hundred eight-eight women, ages 25-39, volunteered to participate in the study. They underwent serological screening for tissue transglutaminase (tTG IgA) and endomysial antibodies (EMA IgA), and measurement of total IgA and both IgA and IgG antigliadin antibodies was done to control for the potential IgA deficiency in some individuals. Four of the 188 patients enrolled in the study were diagnosed with celiac disease, making the prevalence of celiac disease in this population 2.1%. Yet a subgroup analysis of the prevalence of celiac disease in women with unexplained fertility revealed a prevalence of 5.9%, which achieves statistical significance. All four women reported suffering from gastrointestinal symptoms before their diagnosis, and they had a significantly increased prevalence of Irritable Bowel Syndrome as well. The authors admit that this is quite a small sample, and because screening was voluntary, it is also a selected population. But even so, they suggest that physicians should inquire about GI symptoms when patients present with infertility, and that screening for celiac is appropriate in those with unexplained infertility who complain of gastrointestinal distress. They even go so far as to posit that all women with unexplained infertility be screened for celiac, even if they don’t have gastrointestinal trouble. All four women conceived within ten months after starting on a gluten free diet, two naturally and two with help. And all of them went on to deliver healthy babies. Source: Choi JM, Lebwohl B, Wang J, Lee SK, Murray JA, Sauer MV, Green PH. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med. 2011 May-Jun; 56(5-6):199-203.
Jefferson Adams posted an article in Fertility, Pregnancy, Miscarriage and Celiac DiseaseCeliac.com 09/30/2011 - A new study indicates that women who suffer unexplained infertility suffer higher rates of undiagnosed celiac disease than those who do not experience unexplained infertility. The study appeared in the May-June issue of the Journal of Reproductive Medicine. Using serologic screening for celiac disease as well as routine infertility testing, Janet M. Choi, M.D., of Columbia University in New York City, led a study team that included B. Lebwohl, J. Wang, S. K. Lee, J. A. Murray, M. V. Sauer and P. H. R. Green. Together, they assessed 191 women with infertility. The researchers confirmed four women with positive serum test results to have celiac disease. That's 2.1 percent of the 188 patients who completed testing. The women received nutritional counseling to adopt a gluten-free diet. Now, this prevalence rate was not significantly higher than the expected 1.3 percent seen in the general population. However, three cases of undiagnosed celiac disease were seen among the 51 women with unexplained fertility, for a significantly higher prevalence rate of 5.9 percent. Interestingly, all four women found to have celiac disease successfully conceived within a year of diagnosis and treatment. From these results, the team concludes that women with unexplained infertility face a higher risk of undiagnosed celiac disease. They also suggest that this is a risk factor that can be mitigated, and treated. Source: The Journal of Reproductive Medicine