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A K Mandal, I Mehdi, S K Munshi, T C N Lo
Value of routine duodenal biopsy in diagnosing coeliac disease in patients with iron deficiency anaemia
Postgrad Med J 2004; 80: 475-477 [Abstract] [Full text] [PDF]
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[Read eLetter] ? duodenal biopsy
Hema Byrapuneni   (16 November 2004)

? duodenal biopsy 16 November 2004
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Hema Byrapuneni,
Clinical Instructor
Morehouse School of Medicine

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Re: ? duodenal biopsy

byrapuneni{at}yahoo.com Hema Byrapuneni

Dear Editor

I read with great interest the article by Mandal and colleagues,[1] which provides an excellent introduction to duodenal biopsy in iron deficiency anemia.

I agree that duodenal biopsy is the gold standard for diagnosing celiac disease. However, is an invasive test like duodenal biopsy necessary? There are noninvasive tests such as IgA transglutaminase antibodies which have sensitivity of 90-98% and specificity of 95-97%. Furthermore the prevalence of celiac disease is so low that it is not feasible in terms of risk associated with the procedures and cost wise to do in all iron deficiency anemia patients without lesions in EGD and colonoscopy.

I think we should perform biopsies in people who have transglutaminase antibodies and are antigliadin antibodies positive.

Reference

1. Mandal AK, Mehdi I, Munshi SK, Lo TCN. Value of routine duodenal biopsy in diagnosing coeliac disease in patients with iron deficiency anemia. Postgrad Med J 2004;80:475-477.