Celiac disease, a study confirms the importance of screening in subjects with iron deficiency

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Iron deficiency is one of the most common nutritional deficiencies throughout the world, a phenomenon which affects both developed and developing countries. There are many possible causes of iron deficiency, the most common being blood loss and poor absorption of iron in the intestine.

Celiac disease can lead to the reduced intestinal absorption of many nutrients, including iron. Indeed, iron deficiency is one of the typical non-intestinal symptoms of the disease. In addition, the symptoms of iron-deficiency anemia - such as asthenia, irritability, and chronic tiredness - are identical to those of celiac disease (especially in the female population). Therefore, anemia may provide a starting point for the formulation of a diagnosis of celiac disease; especially, in those subjects who do not present with the typical gastrointestinal symptoms (abdominal pain and bloating, diarrhea, constipation, and nausea).
 
A new American study confirms that the prevalence of celiac disease sufferers is higher in the female population with iron deficiency. The authors specify that the objective of the study was precisely to determine the need to screen patients with iron deficiency for celiac disease.

Examining the data from the National Health and Nutrition Examination Survey (NHANES), a large-scale survey on the health status and dietary habits of the American population, researchers from Michigan State University in Flint (USA) examined a sample of 2105 women (aged 6 and upwards), identifying the subjects with iron deficiency and those with celiac disease. Iron deficiency was defined as a serum ferritin level <20 ng/ml; while celiac disease was identified in those subjects testing positive for IgA and IgG anti-transglutaminase antibodies.
 
The results were published in the Journal of Community Hospital Internal Medicine Perspectives. In the sample of 2,105 subjects: 569 were iron deficient, while the tests for celiac disease were positive for 5 subjects from this group versus 2 from the group without iron deficiency. Following adjustment for the variables to be considered, the study results confirm that the prevalence of celiac disease is higher in the female population with iron deficiency, with OR of 12.5 (CI 95% 1.74-90).
 
The researchers concluded that given the treatable nature of gluten hypersensitivity, testing for celiac disease should be considered in patients with iron deficiency when other obvious causes have been ruled out.

Reference

Abdalla, A., Saifullah, S., M., Osman, M., Baniya, R., Sidahmed, S., LaChance, J. & Bachuwa, G. Prevalence of occult celiac disease in females with iron deficiency in the United States: an NHANES analysis. Journal of Community Hospital Internal Medicine Perspectives. 7 (6), 347-350, doi: https://doi.org/10.1080/20009666.2017.1396169