title: Prevalence of celiac disease in nutritional anemia at a tertiary care center.
abstract: BACKGROUND
  While anemia occurs in 80 % to 90 % of patients with celiac disease (CD), it may be the sole manifestation of CD. The prevalence of CD in Indian patients with nutritional anemia is not known.
  
  
  METHODS
  Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy.
  
  
  RESULTS
  Ninety-six patients [mean ± SD age 32.1 ± 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean ± SD duration of diarrhea in them was 9.7 ± 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B12 deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration.
  
  
  CONCLUSIONS
  CD screening should be included in the work up of otherwise unexplained nutritional anemia.
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Kavimandan
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Sharma
authors.forename: Anil K
authors.initials: AK
authors.lastname: Verma
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Das
authors.forename: Prabhash
authors.initials: P
authors.lastname: Mishra
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sinha
authors.forename: Anant
authors.initials: A
authors.lastname: Mohan
authors.forename: V
authors.initials: V
authors.lastname: Sreenivas
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Datta Gupta
authors.forename: Govind K
authors.initials: GK
authors.lastname: Makharia
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D001803:Blood Transfusion; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D055050:Diet, Gluten-Free; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D007194:India / Q000453:epidemiology; D007501:Iron / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D006397:Hematinics; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12