Assessment of the Predictive Factors Influencing the Diagnosis and Severity of Villous Atrophy in Patients with Celiac Disease and Iron Deficiency Anemia Referred for Diagnostic Endoscopy in Basrah, Iraq

Background: The classic celiac disease (CD) presentation in individuals with iron deficiency anemia (IDA) has been changed given the large percentage of subtle or asymptomatic cases. The study objective was to assess the predictive factors influencing the diagnosis and severity of villous atrophy in individuals with CD and IDA referred for a diagnostic endoscopy. Methods: This was a retrospective observational, cross-sectional analysis of the medical records of 499 individuals with IDA in 2 centers in Basrah, Iraq, who referred for possible diagnosis of CD within 10 years (2006-2016). The relationship of the severity of anemia, demographic characteristics, symptomatology, and celiac serological results on the final diagnostic endoscopic evaluation was evaluated using a univariate analysis, at a P value ≤ 0.05. The study adopted the Marsh classification for celiac disease diagnosis where Marsh type 3 represents the definite celiac disease. Results: The definite diagnosis was seen in 44.5% of the cohort (n = 222), with asymptomatic cases representing 22.5% of cases (n = 50). The mean age was (27 ± 11) years, with significant association to (female gender, age ≤45 years, positive celiac serology, and severity of anemia). After adjustment of the variables, the Marsh type was significantly correlated with positive celiac serology, low hemoglobin, and presence of gastrointestinal symptoms. Conclusion: The positive celiac serology, low hemoglobin <9 g/L, and the presence of gastrointestinal symptoms are strong predictors of the severity of villous atrophy (Marsh type).