Year 2011 / Volume 103 / Number 7
Original
Refractory iron-deficiency anemia and gluten intolerance – Response to gluten-free diet

pp. 349-354

Luis Rodrigo Sáez, Dolores Fuentes Álvarez, Isabel Pérez Martínez, Noemí Álvarez Mieres1, Pilar Niño García, Ruth de Francisco García, Sabino Riestra Menéndez, Santiago Vivas Alegrey José Luis Olcoz Goñi

Abstract
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 HLADQ2/ 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.
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Luis Rodrigo Sáez, Dolores Fuentes Álvarez, Isabel Pérez Martínez, Noemí Álvarez Mieres1, Pilar Niño García, Ruth de Francisco García, Sabino Riestra Menéndez, Santiago Vivas Alegrey José Luis Olcoz Goñi. Refractory iron-deficiency anemia and gluten intolerance – Response to gluten-free diet. 349-354


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