Refractory iron-deficiency anemia and gluten intolerance - Response to gluten-free diet.
| Autor: | Sáez LR; Department of Digestive Diseases, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. lrodrigosaez@gmail.com, Álvarez DF, Martínez IP, Mieres NA, García PN, García Rde F, Menéndez SR, Alegre SV, Goñi JL |
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| Jazyk: | English; Spanish; Castilian |
| Zdroj: | Revista espanola de enfermedades digestivas [Rev Esp Enferm Dig] 2011 Jul; Vol. 103 (7), pp. 349-54. |
| DOI: | 10.4321/s1130-01082011000700003 |
| Abstrakt: | Introduction: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common. Objectives: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients. Methods: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response. Results: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes.Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects. Conclusions: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development. |
| Databáze: | MEDLINE |
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