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Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet

Celiac disease (CD) is an autoimmune disorder characterized by intolerance to dietary gluten in genetically predisposed subjects. Iron deficiency anemia (IDA) is a common sign in CD, being the only abnormality in approximately 40% of celiac patients. A multifactorial etiology leads to IDA in CD. The...

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Autores principales: Stefanelli, Gianpiero, Viscido, Angelo, Longo, Salvatore, Magistroni, Marco, Latella, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468819/
https://www.ncbi.nlm.nih.gov/pubmed/32708019
http://dx.doi.org/10.3390/nu12082176
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author Stefanelli, Gianpiero
Viscido, Angelo
Longo, Salvatore
Magistroni, Marco
Latella, Giovanni
author_facet Stefanelli, Gianpiero
Viscido, Angelo
Longo, Salvatore
Magistroni, Marco
Latella, Giovanni
author_sort Stefanelli, Gianpiero
collection PubMed
description Celiac disease (CD) is an autoimmune disorder characterized by intolerance to dietary gluten in genetically predisposed subjects. Iron deficiency anemia (IDA) is a common sign in CD, being the only abnormality in approximately 40% of celiac patients. A multifactorial etiology leads to IDA in CD. The two main causes are the villous atrophy of the mucosa at the site of iron absorption (the duodenum) and the resulting inflammation, which triggers the mechanism that leads to the anemia of chronic disease. Until now, it has been unclear why some patients with CD continue to have IDA despite a careful gluten-free diet (GFD) and the normalization of villous atrophy. Furthermore, some celiac patients are refractory to oral iron supplementation despite the healing of the mucosa, and they thus require periodic intravenous iron administration. The Marsh classification evaluates the degree of inflammation and villous atrophy, but it does not assess the possible persistence of ultrastructural and molecular alterations in enterocytes. The latter was found in CD in remission after adopting a GFD and could be responsible for the persistently reduced absorption of iron and IDA. Even in non-celiac gluten sensitivity, anemia is present in 18.5–22% of patients and appears to be related to ultrastructural and molecular alterations in intestinal microvilli. It is possible that a genetic component may also play a role in IDA. In this review, we evaluate and discuss the main mechanisms of IDA in CD and the possible causes of its persistence after adopting a GFD, as well as their therapeutic implications.
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spelling pubmed-74688192020-09-04 Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet Stefanelli, Gianpiero Viscido, Angelo Longo, Salvatore Magistroni, Marco Latella, Giovanni Nutrients Review Celiac disease (CD) is an autoimmune disorder characterized by intolerance to dietary gluten in genetically predisposed subjects. Iron deficiency anemia (IDA) is a common sign in CD, being the only abnormality in approximately 40% of celiac patients. A multifactorial etiology leads to IDA in CD. The two main causes are the villous atrophy of the mucosa at the site of iron absorption (the duodenum) and the resulting inflammation, which triggers the mechanism that leads to the anemia of chronic disease. Until now, it has been unclear why some patients with CD continue to have IDA despite a careful gluten-free diet (GFD) and the normalization of villous atrophy. Furthermore, some celiac patients are refractory to oral iron supplementation despite the healing of the mucosa, and they thus require periodic intravenous iron administration. The Marsh classification evaluates the degree of inflammation and villous atrophy, but it does not assess the possible persistence of ultrastructural and molecular alterations in enterocytes. The latter was found in CD in remission after adopting a GFD and could be responsible for the persistently reduced absorption of iron and IDA. Even in non-celiac gluten sensitivity, anemia is present in 18.5–22% of patients and appears to be related to ultrastructural and molecular alterations in intestinal microvilli. It is possible that a genetic component may also play a role in IDA. In this review, we evaluate and discuss the main mechanisms of IDA in CD and the possible causes of its persistence after adopting a GFD, as well as their therapeutic implications. MDPI 2020-07-22 /pmc/articles/PMC7468819/ /pubmed/32708019 http://dx.doi.org/10.3390/nu12082176 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Stefanelli, Gianpiero
Viscido, Angelo
Longo, Salvatore
Magistroni, Marco
Latella, Giovanni
Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet
title Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet
title_full Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet
title_fullStr Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet
title_full_unstemmed Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet
title_short Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite a Gluten-Free Diet
title_sort persistent iron deficiency anemia in patients with celiac disease despite a gluten-free diet
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468819/
https://www.ncbi.nlm.nih.gov/pubmed/32708019
http://dx.doi.org/10.3390/nu12082176
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