Mild enteropathy as a cause of iron-deficiency anaemia of previously unknown origin

• Published in: Digestive and liver disease Vol. 43; no. 6; pp. 448 - 453
• Main Authors: Monzón, Helena, Forné, Monserrat, González, Clarisa, Esteve, Maria, Martí, Josep M, Rosinach, Mercè, Mariné, Meritxell, Loras, Carme, Espinós, Jorge C, Salas, Antonio, Viver, Josep M, Fernández-Bañares, Fernando
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-06-2011
• Subjects: Adult; Anemia, Iron-Deficiency - etiology; Anemia, Iron-Deficiency - therapy; Celiac Disease - complications; Celiac Disease - diagnosis; Celiac Disease - diet therapy; Diet, Gluten-Free; Female; Gastroenterology and Hepatology; Gluten-sensitive enteropathy; Helicobacter Infections - complications; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Helicobacter pylori infection; Humans; Iron-deficiency anaemia; Male; Middle Aged; Mild enteropathy; Prospective Studies; Helicobacter pylori infection; Iron-deficiency anaemia; Mild enteropathy; Gluten-sensitive enteropathy
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2010.12.003

Abstract Background and aims We assessed whether mild enteropathy with negative coeliac serology may be gluten-dependent, and a cause of iron-deficiency anaemia. In cases not responding to gluten-free diet, the role of Helicobacter pylori infection was evaluated. Methods 55 consecutive unexplained iron-deficiency anaemia patients were included. In all of them we performed: HLA-DQ2/DQ8 coeliac genetic study, distal duodenum biopsies, and tests to assess H. pylori infection. A gluten-free diet or H. pylori eradication was used as indicated. Final diagnosis was established based on response to specific therapy after a 12-month follow-up period. Results Histological findings were: (1) group A (positive genetics): 21 Marsh I, 2 Marsh IIIA, 12 normal; (2) group B (negative genetics): 16 Marsh I, 4 normal. Final diagnosis of anaemia in patients with enteropathy were: group A, gluten-sensitive enteropathy, 45%; H. pylori infection, 20%; gluten-sensitive enteropathy plus H. pylori , 10%; other, 10%; unknown, 15%; group B, gluten-sensitive enteropathy, 10%; H. pylori infection, 0% (1 non-eradicated case, 10%); non-steroidal anti-inflammatory drug intake, 20%; other, 20%; unknown, 40% ( p = 0.033). Conclusions Mild enteropathy is frequent in patients with unexplained iron-deficiency anaemia and negative coeliac serology. Most cases are secondary to either gluten-sensitive enteropathy or H. pylori infection, or both; however, there is also a substantial number of patients without a definitive diagnosis.