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World J Gastroenterol. Dec 28, 2008; 14(48): 7381-7385
Published online Dec 28, 2008. doi: 10.3748/wjg.14.7381
Gluten sensitive enteropathy in patients with iron deficiency anemia of unknown origin
Farhad Zamani, Mehdi Mohamadnejad, Ramin Shakeri, Afsaneh Amiri, Safa Najafi, Seyed Meysam Alimohamadi, Seyed Mohamad Tavangar, Ardeshir Ghavamzadeh, Reza Malekzadeh
Farhad Zamani, Mehdi Mohamadnejad, Afsaneh Amiri, Gastrointestinal and Liver Disease Research Centre, Iran University of Medical Sciences, Tehran, Iran
Ramin Shakeri, Seyed Meysam Alimohamadi, Reza Malekzadeh, Digestive Disease Research Centre, Tehran University of Medical Sciences, Tehran 14117-13135, Iran
Safa Najafi, Ardeshir Ghavamzadeh, Hematology, Oncology, BMT research Center, Tehran University of Medical Sciences, Tehran 14117-13135, Iran
Seyed Mohamad Tavangar, Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran 14117-13135, Iran
Author contributions: Zamani F and Mohamadnejad M participated in conception, design, undertaking of the study and manuscript writing; Shakeri R and Amiri A participated in data collection, data analysis and manuscript writing; Malekzadeh R participated in conception and experimental design of study. Other authors participated in data collection.
Supported by Local funds from Digestive Disease Research Centre, University of Tehran and Gastrointestinal and Liver Disease Research Centre, Iran University of Medical Science
Correspondence to: Reza Malekzadeh, Professor, Digestive Disease Research Center, Shariati Hospital, North Kargar Ave, Tehran 14117-13135, Iran. malek@ams.ac.ir
Telephone: +98-21-88012992 Fax: +98-21-88012992
Received: October 15, 2008
Revised: December 3, 2008
Accepted: December 10, 2008
Published online: December 28, 2008

AIM: To determine the prevalence of gluten sensitive enteropathy (GSE) in a large group of patients with iron deficiency anemia (IDA) of obscure origin.

METHODS: In this cross-sectional study, patients with IDA of obscure origin were screened for GSE. Anti-endomysial antibody (EMA) and tissue transglutaminase antibody (tTG) levels were evaluated and duodenal biopsies were taken and scored according to the Marsh classification. The diagnosis of GSE was based on a positive serological test and abnormal duodenal histology. Gluten free diet (GFD) was advised for all the GSE patients.

RESULTS: Of the 4120 IDA patients referred to our Hematology departments, 206 (95 male) patients were found to have IDA of obscure origin. Thirty out of 206 patients (14.6%) had GSE. The mean age of GSE patients was 34.6 ± 17.03 (range 10-72 years). The female to male ratio was 1.3:1. Sixteen patients had Marsh 3, 12 had Marsh 2, and 2 had Marsh 1 lesions. The severity of anemia was in parallel with the severity of duodenal lesions. Twenty-two GSE patients (73.3%) had no gastrointestinal symptoms. Fourteen GSE patients who adhered to GFD without receiving iron supplementation agreed to undergo follow up visits. After 6 mo of GFD, their mean hemoglobin levels (Hb) increased from 9.9 ± 1.6 to 12.8 ± 1.0 g/dL (P < 0.01). Interestingly, in 6 out of 14 patients who had Marsh 1/2 lesions (e.g. no villous atrophy) on duodenal biopsy, mean Hb increased from 11.0 ± 1.1 to 13.1 ± 1.0 g/dL (P < 0.01) while they did not receive any iron supplementation.

CONCLUSION: There is a high prevalence (e.g. 14.6%) of GSE in patients with IDA of obscure origin. Gluten free diet can improve anemia in GSE patients who have mild duodenal lesions without villous atrophy.

Keywords: Gluten sensitive enteropathy, Iron deficiency anemia, Anti-Tissue transglutaminase antibody, Anti-endomysial antibody, Gluten free diet