Is routine duodenal biopsy necessary for the detection of celiac disease in patients presenting with iron deficiency anemia?

Iron deficiency anemia [IDA] is one of the well recognized presentations of celiac disease [CD]. According to the lack of data from our population in this regard, we determined the prevalence of CD in patients presenting with IDA to see if it is worthwhile to do a precise screening for CD in such patients. This cross-sectional study was conducted on patients referred with IDA to Poursina Hakim Gastroenterology Clinic, Isfahan [IRAN]. All included patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Also, patients were evaluated for IgA anti-tissue transglutaminase [t-TG] antibody with enzyme-linked immunosorbent assay [ELISA] technique. CD was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten free diet [GFD]. During the study, 130 patients with the mean age of 35.5 +/- 13.7 [67.7% female [20.4% post-menopausal]] were undergone seropathological studies. According to histopathological study and a clinical response to GFD, 13 patients [10%] were ultimately diagnosed with CD. Nine patients [6.9%] were seropositive, from which, five patients [3.8%] were ultimately diagnosed as CD cases. IgA anti-tTG became negative in all of these patients after six months of GFD. CD should be considered in any adult patient presenting with unexplained IDA, even if not accompanied with gastrointestinal symptoms. Routine duodenal biopsy performed during diagnostic upper gastrointestinal endoscopy is worthwhile in order to investigate for CD as an underlying cause of IDA in adult patients

Should we look for celiac disease among all patients with liver function test abnormalities?

Celiac disease [CD] has been found in up to 10% of the patients presenting with unexplained abnormal liver function tests [LFT]. As there is no precise data from our country in this regard, we investigated the prevalence of CD in patients presenting with abnormal LFT. From 2003 to 2008, we measured IgA anti-tissue transglutaminase [t-TG] antibody [with ELISA technique] within the first-level screening steps for all patients presenting with abnormal LFT to three outpatient gastroenterology clinics in Isfahan, IRAN. All subjects with an IgA anti-tTG antibody value of>10 ?/ml [seropositive] were undergone upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. CD was defined as being seropositive with Marsh I or above in histopathology and having a good response to gluten free diet [GFD]. During the study, 224 patients were evaluated, out of which, 10 patients [4.4%] were seropositive for CD. Duodenal biopsies were performed in eight patients and revealed six [2.7%] cases of Marsh I or above [four Marsh IIIA, two Marsh I], all of them had good response to GFD. The overall prevalence of CD among patients with hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis was determined as 10.7% [3/28], 3.4% [2/59], and 5.3% [1/19], respectively. Serological screening with IgA anti-tTG antibody test should be routinely performed in patients presenting with abnormal LFT and especially those with chronic liver diseases including hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis