Diagnostic Prevalence of Celiac Disease by Routine Duodenum Biopsy in Adult Patients with Iron Deficiency

Abstract

Objective:Iron deficiency anemia (IDA) frequently emerges as a consequence of Celiac disease (CeD), and in some cases, it can be the sole clinical manifestation of the condition, especially among patients with subclinical or atypical forms. Histological analysis plays a pivotal role in the diagnostic process. Our study aimed to assess the significance of duodenal biopsies in diagnosing CeD among patients with IDA of unknown origin and to determine the prevalence of CeD within the group of patients with unexplained IDA.Method:Between June 2019 and December 2022, we enrolled 248 consecutive patients aged 18 and above who underwent duodenal biopsies during esophagogastroduodenoscopy procedures for evaluating unexplained IDA in our endoscopy unit. A retrospective analysis of CeD prevalence was performed. Patients with abnormal duodenal histology were tested for anti-endomysium antibody and tissue transglutaminase antibody levels. A positive serological test along with abnormal duodenal histology confirmed the diagnosis of CeD. Histopathological changes were categorized according to the Marsh classification.Results:A total of 248 patients, including 171 women, meeting the study criteria were included. CeD was identified in 8 (3.2%) patients who underwent duodenum biopsies. The average age of celiac patients was 36±14 years, and the female-to-male ratio was 1.3:1. Histopathology revealed Marsh III in 5 (62.5%) patients, Marsh II in 2 (25%), and Marsh I with lesions in 1 (12.5%) patient. All patients with pathological changes in duodenal biopsies (Marsh I, II & III) tested positive serologically. No significant differences were observed in mean hemoglobin, mean corpuscular volume, and ferritin levels between patients with and without CeD accompanied by IDA.Conclusion:Routine duodenum biopsies performed during upper endoscopic examinations of IDA patients contribute to a diagnostic yield of 3.2% for CeD. Thus, even in cases where the endoscopic appearance of the mucosa seems normal, this procedure should be routinely integrated into the diagnostic evaluation of patients with IDA.

Keywords

• celiac disease
• duodenal biopsy
• iron deficiency anemia