A controlled, prospective screening study of celiac disease presenting as iron deficiency anemia.
BACKGROUND
anemia is the most frequent presenting feature of celiac disease in adults using endomysial antibody (EmA) screening. Endomysial antibody screening of anemia may allow detection of celiac disease at an earlier stage of investigation and after a shorter duration of symptoms. The characteristics of celiac patients identified by screening require further study.


OBJECTIVE
a goal of this study was to evaluate the prevalence of celiac disease in adult patients with iron deficiency anemia compared with a nonanemic control population using immunoglobulin A (IgA) EmA screening. We also studied the positive predictive value (PPV) of the EmA assay and correlated the severity of histologic abnormalities in distal duodenal biopsy samples with EmA and tissue transglutaminase (tTG) antibody titer.


METHODS
four hundred eighty-four patients with microcytic, hypochromic anemia underwent IgA EmA assay. Four hundred ninety-eight nonanemic age- and sex-matched patients from the same source comprised the control group. Patients with positive serology results were invited for endoscopic duodenal biopsies.


RESULTS
one in 44 anemic patients was diagnosed with histologically confirmed celiac disease compared with one in 498 nonanemic patients ( < 0.01). Fifty percent of women were premenopausal, and 25% of patients were older than 65 years. The PPV for EmA assay varied between 73% and 93% for anemic patients and improved at higher antibody titer, with all false-positive results occurring at the lowest titers.


CONCLUSIONS
screening for celiac disease using IgA EmA assay is effective in anemic patients, including premenopausal women and patients older than 65 years, and it can be recommended in clinical practice.
Department of Gastroenterology, County Hospital, Union Walk, Hereford, UK. rupert.ransford@HH-TR.WMIDS.NHS.UK
Rupert A J
RA
Ransford
Mark
M
Hayes
Martin
M
Palmer
Michael J
MJ
Hall
D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology*; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012698:Serologic Tests; D011503:Transglutaminases / Q000032:analysis
D007070:Immunoglobulin A; D011503:Transglutaminases