Diagnostic Yield of Routine Duodenal Biopsies in Iron Deficiency Anemia for Celiac Disease Diagnosis

Background. Iron deficiency anemia (IDA) is a recognised feature of celiac disease (CD) in adults and can be its only presentation. Aim. To define the prevalence of CD in Moroccan adult patients with IDA of obscure origin and to determine the yield of small bowel biopsy performed during routine endoscopy. Methods. 437 patients with IDA of obscure origin were included. 4 endoscopic mucosal biopsies were taken from the second part of duodenum and 2 biopsies from antrum and fundus, respectively. Endoscopic aspect and severity of anemia were correlated with histological diagnoses using coefficient Kappa. Results. 29 out of 437 patients (6.63%) had CD. Endoscopic aspect was normal in 66%, a mosaic pattern of mucosa in 17%, and scalloping of the small bowel folds in 17%. 12 patients had Marsh III, 8 had Marsh II, 6 had Marsh I, and 3 had Marsh IV lesions. There was no correlation between degree of anemia, endoscopic aspect, and severity of duodenal lesions . Conclusion. Routine duodenal biopsy gives an additional 6.63% diagnostic benefit of CD and should be indicated in all patients with IDA. The finding of normal endoscopic appearance of mucosa should not preclude duodenal biopsies. 1. Background Occult, chronic blood loss from the gastrointestinal tract is the most common cause of iron deficiency anemia. The different lesions responsible for chronic blood loss include both upper and lower gastrointestinal tract sources with causes and incidences varying widely among different studies [1]. First described in 1888 by Samuel Gee, adult celiac disease has now been well recognized as a disease characterized by damage to the small bowel mucosa induced by gluten. Adult celiac disease can be a cause of malabsorption of several nutrients in addition to having a malignant potential. Anemia can be a presenting and/or significant feature of this disease and can occur in any age, sex, or ethnic group [1]. This autoimmune enteropathy is common not only in Europe but also in African populations, specifically in the Maghreb area. The primary aim of this study is to define the prevalence of CD in Moroccan adult patients with iron deficiency anemia of obscure origin and to determine the yield of small bowel biopsyperformed during routine endoscopy. The secondary one is to determine the correlation between degree of anemia, endoscopic aspect, and severity of duodenal lesions. 2. Methods We retrospectively studied 437 patients with IDA of obscure origin and nonspecific gastrointestinal symptoms are collected between 2005 and 2011. All patients had a diagnosis of IDA with