Newly detected celiac disease by wireless capsule endoscopy in older adults with iron deficiency anemia

The prevalence of celiac disease (CD) is estimated to be 1% in the US population, yet many cases are undiagnosed. CD might present itself in the older adults (age >60 y) for the first time, solely with iron deficiency anemia (IDA). Recent studies indicate that approximately 20% of newly diagnosed CD patients are older than 60 years. Wireless capsule endoscopy (WCE) identifies small bowel mucosal abnormalities by direct visualization. Incidental findings observed by WCE indicative of CD prompt confirmatory diagnostic tests such as IgA class antitissue transglutaminase antibody and IgA class antiendomysial antibody.

To present the frequency of mucosal abnormalities and their location suggestive of CD observed by WCE, in the older adults with IDA.

In this retrospective study, data is collected from patients who underwent WCE mostly for the evaluation of IDA with or without other symptoms such as obscure gastrointestinal bleeding, abdominal pain, and chronic diarrhea over a period of 5 years (2002 to 2007).

Out of 652 cases of WCE, 360 were older adults (age >60 y). Evaluation of IDA was the indication in 279 out of 360 (78%) older adults. Among the 279 older adults with IDA, 7 (2.5%) had mucosal abnormalities suggestive of CD (atrophy, scalloping, mosaicism, layering, and nonspecific ulcerating jejuno-ileitis). Subsequent evaluation with serum antibody testing +/-multiple distal duodenal biopsies confirmed the diagnosis in all patients. Five out of 7 (71%) older adults had normal looking duodenal mucosa on WCE, but had classic abnormalities of CD distally.

(1) Mucosal abnormalities of CD may be seen on WCE for the first time, in the older adults with IDA with no past clinical picture of the disease. (2) Duodenum may be entirely normal by esophagogastroduodenoscopy examination; whereas the proximal and distal intestine may show classic features of CD by WCE.