Is Routine Duodenal Biopsy Necessary for the Detection of Celiac Disease in Patients Presenting with Iron Deficiency Anemia?

Backgrounds: iron deficiency anemia (ida) is one of the wellrecognized presentations of celiac disease (cd). according to thelack of data from our population in this regard, we determined theprevalence of cd in patients presenting with ida to see if it isworthwhile to do a precise screening for cd in such patients.methods: this cross-sectional study was conducted on patientsreferred with ida to poursina hakim gastroenterologyclinic, isfahan (iran). all included patients underwent uppergastrointestinal endoscopy and duodenal biopsy. histopathologicalchanges 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 abovehistopathology or being seropositive with marsh i histopathologyand having a good response to gluten free diet (gfd).results: during the study, 130 patients with the mean age of35.5±13.7 (67.7% female [20.4% post-menopausal]) were undergoneseropathological studies. according to histopathological studyand a clinical response to gfd, 13 patients (10%) were ultimatelydiagnosed with cd. nine patients (6.9%) were seropositive, fromwhich, five patients (3.8%) were ultimately diagnosed as cd cases.iga anti-ttg became negative in all of these patients after sixmonths of gfd.conclusion: cd should be considered in any adult patientpresenting with unexplained ida, even if not accompanied withgastrointestinal symptoms. routine duodenal biopsy performedduring diagnostic upper gastrointestinal endoscopy is worthwhilein order to investigate for cd as an underlying cause of ida inadult patients.