ORIGINAL ARTICLE

Value of routine duodenal biopsy in diagnosing coeliac disease in patients with iron deficiency anaemia

A K Mandal, I Mehdi, S K Munshi, T C N Lo

Department of Integrated Medicine, Leicester General Hospital, Leicester, UK

Correspondence to:
Correspondence to:
Dr Aditya Mandal
County Hospital, Lincoln LN2 5QY, UK; adityamandal{at}hotmail.com

Background: Iron deficiency anaemia (IDA) is a recognised feature of coeliac disease in adults and can be its only presentation.

Objective: To determine the yield of routine distal duodenal biopsies in diagnosing coeliac disease in adult and elderly patients with IDA whose endoscopy revealed no upper gastrointestinal cause of iron deficiency.

Study design: Prospective study in a teaching hospital endoscopy unit.

Method: Altogether 504 consecutive patients with IDA, aged 16–80 years, attending for endoscopy were included in this study. At least two distal duodenal biopsies were taken if endoscopy revealed no cause of iron deficiency.

Result: In nine (1.8%) patients duodenal biopsies revealed typical histological features of coeliac disease. Of these, five patients were above 65 years old.

Conclusion: In adult and elderly patients undergoing endoscopy for IDA, the endoscopist should take distal duodenal biopsies to exclude coeliac disease if no upper gastrointestinal cause of anaemia is found. Coeliac disease is not an uncommon cause of IDA in patients >65 years of age and a history of chronic diarrhoea increases diagnostic yield in this age group.

Abbreviations: IDA, iron deficiency anaemia; OGD, oesophagogastroduodenoscopy

Keywords: coeliac disease; duodenal biopsy; iron deficiency anaemia

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• Hershko, C., Patz, J. (2008). Ironing out the mechanism of anemia in celiac disease. haematol 93: 1761-1765 [Full Text]  
• Halfdanarson, T. R., Litzow, M. R., Murray, J. A. (2007). Hematologic manifestations of celiac disease. Blood 109: 412-421 [Abstract] [Full Text]  
• Masci, E, Mangiavillano, B, Albarello, L, Mariani, A, Doglioni, C, Testoni, P A (2006). Optical coherence tomography in the diagnosis of coeliac disease: a preliminary report.. Gut 55: 579-579 [Full Text]  

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