title: Refractory iron-deficiency anemia and gluten intolerance - Response to gluten-free diet.
abstract: BACKGROUND
  refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common.
  
  
  OBJECTIVE
  to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients.
  
  
  METHODS
  a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response.
  
  
  RESULTS
  ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes.Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects.
  
  
  CONCLUSIONS
  celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development.
authors.affiliation: Department of Digestive Diseases, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. lrodrigosaez@gmail.com
authors.forename: Luis Rodrigo
authors.initials: LR
authors.lastname: Sáez
authors.forename: Dolores Fuentes
authors.initials: DF
authors.lastname: Álvarez
authors.forename: Isabel Pérez
authors.initials: IP
authors.lastname: Martínez
authors.forename: Noemí Alvarez
authors.initials: NA
authors.lastname: Mieres
authors.forename: Pilar Niño
authors.initials: PN
authors.lastname: García
authors.forename: Ruth de Francisco
authors.initials: Rde F
authors.lastname: García
authors.forename: Sabino Riestra
authors.initials: SR
authors.lastname: Menéndez
authors.forename: Santiago Vivas
authors.initials: SV
authors.lastname: Alegre
authors.forename: José Luis Olcoz
authors.initials: JL
authors.lastname: Goñi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000747:Anemia, Hypochromic / Q000150:complications / Q000178:diet therapy* / Q000235:genetics; D001284:Atrophy; D001706:Biopsy; D001774:Blood Chemical Analysis; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000235:genetics; D003113:Colonoscopy; D055050:Diet, Gluten-Free; D005260:Female; D005802:Genes, MHC Class II / Q000235:genetics; D020022:Genetic Predisposition to Disease; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D007136:Immunoglobulins