title: Mild enteropathy as a cause of iron-deficiency anaemia of previously unknown origin.
abstract: OBJECTIVE
  We assessed whether mild enteropathy with negative coeliac serology may be gluten-dependent, and a cause of iron-deficiency anaemia. In cases not responding to gluten-free diet, the role of Helicobacter pylori infection was evaluated.
  
  
  METHODS
  55 consecutive unexplained iron-deficiency anaemia patients were included. In all of them we performed: HLA-DQ2/DQ8 coeliac genetic study, distal duodenum biopsies, and tests to assess H. pylori infection. A gluten-free diet or H. pylori eradication was used as indicated. Final diagnosis was established based on response to specific therapy after a 12-month follow-up period.
  
  
  RESULTS
  Histological findings were: (1) group A (positive genetics): 21 Marsh I, 2 Marsh IIIA, 12 normal; (2) group B (negative genetics): 16 Marsh I, 4 normal. Final diagnosis of anaemia in patients with enteropathy were: group A, gluten-sensitive enteropathy, 45%; H. pylori infection, 20%; gluten-sensitive enteropathy plus H. pylori, 10%; other, 10%; unknown, 15%; group B, gluten-sensitive enteropathy, 10%; H. pylori infection, 0% (1 non-eradicated case, 10%); non-steroidal anti-inflammatory drug intake, 20%; other, 20%; unknown, 40% (p=0.033).
  
  
  CONCLUSIONS
  Mild enteropathy is frequent in patients with unexplained iron-deficiency anaemia and negative coeliac serology. Most cases are secondary to either gluten-sensitive enteropathy or H. pylori infection, or both; however, there is also a substantial number of patients without a definitive diagnosis.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mútua Terrassa and Research Foundation Mútua Terrassa, Barcelona, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Monzón
authors.forename: Monserrat
authors.initials: M
authors.lastname: Forné
authors.forename: Clarisa
authors.initials: C
authors.lastname: González
authors.forename: Maria
authors.initials: M
authors.lastname: Esteve
authors.forename: Josep M
authors.initials: JM
authors.lastname: Martí
authors.forename: Mercè
authors.initials: M
authors.lastname: Rosinach
authors.forename: Meritxell
authors.initials: M
authors.lastname: Mariné
authors.forename: Carme
authors.initials: C
authors.lastname: Loras
authors.forename: Jorge C
authors.initials: JC
authors.lastname: Espinós
authors.forename: Antonio
authors.initials: A
authors.lastname: Salas
authors.forename: Josep M
authors.initials: JM
authors.lastname: Viver
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Bañares
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000628:therapy; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy; D055050:Diet, Gluten-Free; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies