title: Prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin in Kashmir (India).
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin.
  
  
  METHODS
  One hundred and sixty-one consecutive patients with iron-deficiency anemia of obscure origin were evaluated. Tissue transglutaminase antibodies levels were done and duodenal biopsies were scored according to Marsh classification. Diagnosis was based on positive IgA anti-tissue transglutaminase antibodies and abnormal histopathology. Gluten-free diet (GFD) was adviced for celiac disease patients. One hundred and sixty healthy blood donors were tested for IgA anti-tissue transglutaminase antibodies, and positive controls were subjected to endoscopic duodenal biopsy.
  
  
  RESULTS
  Tissue transglutaminase antibodies were positive in 13 (8 %) patients with iron-deficiency anemia of obscure origin and 4 (2.5 %) in control group (p = 0.026) (odds ratio 3.42; 95 % confidence interval [CI]: 1.092-10.743). All 13 patients (8 %) and 2 out of 4 positive controls (1.25 %) had histopathology findings of celiac disease (p = 0.004). Duodenal biopsy showed Marsh grade 1 in 4, grade 2 in 4 (30.77 %), 3a in 1 (7.70 %), 3b in 2 (15.38 %), and 3c in 2 (15.38 %) patients. A statistically significant correlation was found between lower hemoglobin concentration and higher Marsh grading (Spearman's rho = -0.946, p = 0.001). Celiac disease patients adhered to GFD and after 6 months mean (SD) hemoglobin levels increased from 7.42 ± 0.96 to 10.47 ± 0.80 g/dL (p- < 0.001).
  
  
  CONCLUSIONS
  Patients with iron-deficiency anemia of obscure origin had increased prevalence of celiac disease. Gluten-free diet improved anemia in celiac disease patients irrespective of grade of duodenal involvement.
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India. guljavid@rediffmail.com.
authors.forename: Gul
authors.initials: G
authors.lastname: Javid
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Shaheen Nazir
authors.initials: SN
authors.lastname: Lone
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Abid
authors.initials: A
authors.lastname: Shoukat
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Bashir Ahmed
authors.initials: BA
authors.lastname: Khan
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Gulam Nabi
authors.initials: GN
authors.lastname: Yattoo
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Altaf
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Jaswinder Singh
authors.initials: JS
authors.lastname: Sodi
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Mushtaq Ahmed
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Department of Gastroentrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India.
authors.forename: Showkat Ali
authors.initials: SA
authors.lastname: Zarger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000150:complications* / Q000453:epidemiology*; D002446:Celiac Disease / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
keywords: Celiac disease; Duodenal biopsy; Gluten-free diet; Iron-deficiency anemia of obscure origin; Tissue transglutaminase antibodies