Clinical Characteristics and the Dietary Response in Celiac Disease Patients Presenting With or Without Anemia.
It remains unclear as to what are the clinical characteristics associated with the presence of anemia at celiac disease diagnosis, and how these are affected by a gluten-free diet. We investigated these issues in a prospective study.



Clinical and demographic data, small-bowel mucosal histology, serology, and laboratory parameters, body mass index (BMI), and bone mineral density (BMD) both at diagnosis and after 1 year on a gluten-free diet were investigated in 163 adults with celiac disease. Gastrointestinal symptoms and psychological well-being were evaluated by validated Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires. All study variables were compared between participants with and without anemia at celiac disease diagnosis.



Altogether, 23% of the patients had anemia at diagnosis. Anemic patients were more often women (P=0.001) and had more gastrointestinal symptoms (P=0.004) and were less often screen detected (P=0.009). Further, they had higher celiac antibody values (P=0.007) and a lower total iron (P<0.001), BMI (P=0.003), and density of mucosal γδ+ intraepithelial lymphocytes (P=0.033). After 1 year on a gluten-free diet, the anemia group had a lower mucosal villous height-crypt depth ratio (P=0.008) and BMI (P=0.050), and higher antibody values (P=0.012) and densities of CD3 (P=0.008) and αβ+ intraepithelial lymphocytes (P=0.022). There was no significant difference between the groups in their bone mineral density, Gastrointestinal Symptom Rating Scale and Psychological General Well-Being.



Celiac patients with anemia had more severe disease than nonanemic patients in terms of the serology and a lower BMI. Further, they evinced a slower histologic response to the dietary treatment. An early diagnosis and careful follow-up are important in these patients.
*School of Medicine ‡School of Health Sciences §Tampere Centre for Child Health Research, University of Tampere Departments of †Internal Medicine #Gastroenterology and Alimentary Track Surgery ∥Tampere Centre for Child Health Research, Tampere University Hospital ¶The UKK Institute for Health Promotion Research, Tampere, Finland.
Johanna
J
Saukkonen
Katri
K
Kaukinen
Anna-Maija
AM
Koivisto
Markku
M
Mäki
Kaija
K
Laurila
Harri
H
Sievänen
Pekka
P
Collin
Kalle
K
Kurppa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D001706:Biopsy; D015992:Body Mass Index; D015519:Bone Density; D002446:Celiac Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy*; D055050:Diet, Gluten-Free; D005260:Female; D006304:Health Status; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D007421:Intestine, Small / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012698:Serologic Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult