Frequency of Celiac Disease in Patients Presenting with Nutritional Anemia

Abstract

Introduction: Celiac disease (CD) is a gluten sensitive enteropathy characterized by villous atrophy of the small intestine in genetically susceptible individuals. Anemia is frequently seen in celiac disease owing to greatly reduced iron, folic acid and B12 absorption.  Objectives: To determine the frequency of celiac disease in patients presenting with nutritional anemias. Study design: Descriptive cross-sectional study Setting: department of Internal Medicine, Services Hospital Lahore. Duration of study: Seven months from May 2017 to December 2017. Sample size: The calculated sample size is 100 cases. Sampling technique: Non-probability purposive sampling. Data collection procedure: 100 consecutive patients presenting with nutritional anemia were enrolled. Complete hematologic workup was done including blood complete picture (CP), peripheral smear, iron, folate and B12 levels. Anemia was defined as Hb <13 g/dL in males and <12 g/dL in females. Only cases with anemia secondary to iron, folate or B12 deficiency i.e. nutritional causes were included in the study Patients were then subjected to anti-tTG antibody testing. Jejunal biopsy was taken in all those cases which tested positive for anti tTG antibody. A diagnosis of CD was established upon positive histopathology findings All the data was recorded on a pre-designed proforma and analyzed by SPSS version 21.0. Results: The prevalence of Celiac disease was found to be 12%.10 out of 12 celiac disease cases were having IDA; 1 each showed dimorphic picture and concomitant B12 + folate deficiency respectively with none of the CD patients having folate or B12 deficiency alone. Conclusion: Celiac disease may be found in up to 12% of Pakistanis presenting with nutritional anemia. Hence, all those patients not responding to standard anemia treatment should be screened for celiac disease.