الفهرس 
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Abstract
Celiac disease is an autoimmune disease which is related to gluten ingestion with many risk factors which help in development of the disease.
Diagnosis of Celiac disease is increasing nowadays due to good awareness and easy serological markers which has high sensitivity and specificity.
Celiac disease can cause both intestinal as (malabsorption, chronic diarrhea, constipation, abdominal pain, distension, and failure to thrive or weight loss) and extraintestinal manifestation which include delayed puberty and short stature, Fatigue and iron deficiency anemia are common, Dermatitis herpetiformis, osteoporosis, and neurologic problems and critical problems like non-Hodgkin’s lymphoma, small bowel adenocarcinoma, esophageal cancer, and melanoma.
Diagnosis of celiac disease is achieved by serological markers as Anti-TTG IGA and IGG and antiendomysial antibodies igG and igA followed by upper GIT endoscopy and duodenal biopsy which is the gold standard investigation to diagnose celiac disease.
Life long gluten free diet remains the gold standard treatment of celiac disease.
Iron deficiency anemia can be the only presentable symptom for the patient. The best treatment of iron deficiency anemia due to celiac disease is a gluten free diet to restore villous architecture and restore the absorption of iron.
The aim of our study was to evaluate the prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin.
The study was designed as a cross sectional study. It included 100 patients with obscure iron deficiency anemia.
Every participant was subjected to the following: Full history of gastrointestinal symptoms of CD e.g. abdominal pains, diarrhea, steatorrhea, abdominal distension, constipation, vomiting, loss of weight), Age of onset of iron deficiency anemia, Complete blood picture, Serum iron, serum ferritin, transferrin saturation, Anti-tissue transglutaminase antibody immunoglobuline A, Upper gastrointestinal endoscopy and duodenal biopsy to patients who had positive serology, Duodenal biopsies were classified according to Modified Marsh classification.
The present study showed that 8% of cases with iron deficiency anemia of obscure origin were ultimately diagnosed as cases of celiac diseases while 47% were diagnosed according to duodenal biopsy as potential celiac disease (where there was positive serology and intact villous architecture according to marsh classification) and 45%of cases were non-celiac disease.
CONCLUSION AND RECOMMENDATIONS
Conclusion
In this study, we conclude that screening for celiac disease is mandatory in patients with obscure iron deficiency anemia
Upper GIT endoscopy is mandatory in patients with positive anti-TTG test even if asymptomatic. Diagnosis of celiac disease helps early treatment of iron deficiency anemia and malabsorption by gluten free diet and restoration of the normal villous architecture.
Recommendations
Based on our study and conclusion, we recommend the following:
Further larger scale studies may be needed for evaluation of prevalence of celiac disease in iron deficiency anemia patients of obscure origin
Potential celiac diseased patients should be followed up by measurement of serological markers and UGI endoscopy for at least 6 months.
Patients with iron deficiency anemia of obscure origin should be tested for Anti-ttg IGA marker to exclude celiac disease and in patients with positive markers should undergo UGI endoscopy.