Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women.
OBJECTIVE
To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori (H pylori) infection and celiac disease in women aged < 50 years affected by iron-deficiency anemia (IDA).


METHODS
One hundred and fifteen women aged < 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies (tTG) and anti-H pylori IgG antibodies. tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay (ELISA). All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum (n = 3), gastric body (n = 3) and duodenum (n = 4) in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh's System.


RESULTS
45.2% women were test-positive: 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239). The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test-negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for H pylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active H pylori infection was found. In particular, in 23 out of 28 (82%) patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body.


CONCLUSIONS
Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.
Vannella
Lucy
L
Department of Digestive and Liver Disease, Sant'Andrea Hospital, Rome, Italy.
Gianni
Debora
D
Lahner
Edith
E
Amato
Antonio
A
Grossi
Enzo
E
Delle Fave
Gianfranco
G
Annibale
Bruno
B
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000503:physiopathology*; D000906:Antibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000276:immunology*; D016145:Endoscopy, Digestive System; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000276:immunology*; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
D000906:Antibodies; D011503:Transglutaminases