Role of Routine Duodenal Biopsy in Patients with Unexplained Iron Deficiency Anemia in Areas of Low Prevalence of Celiac Disease.

Aims: The aim is to assess the usefulness of routine duodenal biopsy in patients presenting with iron deficiency anemia in areas with low prevalence of celiac disease (CD).

Methods: This prospective study included 156 patients with unexplained iron deficiency anemia, referred to the Department of Gastroenterology. JSS Medical College and Hospital, Mysuru, India. All patients underwent upper gastrointestinal (GI) endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Celiac disease was defined as having Marsh II or above on histopathology or being seropositive with Marsh I histopathology and having a good response to gluten-free diet. Furthermore, patients were evaluated for Immunoglobulin A (IgA) anti-tissue transglutaminase (t-TG) antibody with enzyme-linked immunosorbent assay technique.

Results: One hundred and fifty-six patients were included in the study with a mean age of 52.17 ± 16.01 (67.7% of females) who underwent endoscopic duodenal biopsy. Three (1.9%) were diagnosed to have CD on biopsy, which was confirmed with a serological test (IgA Anti t-Tg). Positivity for CD did not correlate with the severity of anemia or GI symptoms.

Conclusions: Celiac disease should be considered in patients presenting with unexplained iron deficiency anemia, even if not accompanied by GI symptoms. Doing initial serological testing followed by duodenal biopsy may be an appropriate approach, especially in areas with a low prevalence of celiac disease. Routine duodenal biopsies did not seem a reasonable approach considering cost-effectiveness and its clinical utility.