David Geffen School of Medicine at UCLA Los Angeles, CA
Introduction: Anemia is a common extraintestinal manifestation of celiac disease (CeD). Although perceived as a predominantly Caucasian disease with a 1% prevalence, CeD also affects other underreported populations, such as the Hispanic population. We aimed to estimate the prevalence of CeD in Hispanic patients presenting with unexplained anemia.
Methods: A cross-sectional study was completed through a clinical management database and electronic medical record after receiving Institution Review Board approval. Adult Hispanic patients with unexplained anemia who underwent upper endoscopy with duodenal biopsies between 2013 and 2020, were included. This study was conducted at the Los Angeles County Department of Health Services, a safety-net public health care system with a predominantly Hispanic (65%) population. Electronic medical records were queried for the diagnosis of biopsy-proven CeD.
Results: 206 subjects underwent upper endoscopy for unexplained anemia, of which 61 were excluded (18 underwent an upper endoscopy without biopsy, 7 were non-Hispanic, and 36 patients had normal hemoglobin levels). Among all Hispanic patients referred for endoscopic evaluation of unexplained anemia (N = 145), the mean age was 53.9 years, and 66% were female. The overall prevalence of biopsy-proven CeD was 4.8% (N = 7/145). In patients with iron-deficiency anemia (IDA) specifically, the prevalence of CeD was 4.5% (N = 3/67). Of the 7 patients with confirmed CeD, only one in retrospect had associated diarrhea. None of the patients had a family history of CeD. Interestingly, only one of five tested patients had positive IgA tissue transglutaminase antibody, and the remainder were seronegative. Other CeD-related laboratory testing including vitamin B12 and liver function tests were unremarkable; thyroid stimulating hormone (TSH) levels were within normal range except for one patient with elevated levels due to poorly controlled hypothyroidism.
Discussion: The prevalence of CeD in adult Hispanic patients with unexplained anemia (unspecified or IDA) is similar to the prevalence in Caucasian patients, a finding not previously reported in the literature. Screening for CeD in patients with unexplained anemia in general, and IDA specifically, is of value in Hispanic patients as well as Caucasian ones. Seronegative CeD requires endoscopic evaluation with duodenal biopsies for diagnosis.
