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Celiac disease patients presenting with anemia have more severe disease than those presenting with diarrhea
Hussein Abu Daya1, Benjamin Lebwohl, Suzanne K Lewis
1Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
Insights
Patients with celiac disease presenting with anemia, a silent symptom, have more severe disease than those with diarrhea. Anemia in celiac disease is linked to worse outcomes and requires further investigation.
Area of Science:
- Gastroenterology
- Internal Medicine
- Hematology
Background:
- Celiac disease (CD) is an autoimmune disorder.
- CD classically presents with diarrhea, but anemia is a recognized atypical presentation.
- Disease severity comparison between these presentations is not well-established.
Purpose of the Study:
- To compare the severity of celiac disease in patients presenting with anemia versus those presenting with diarrhea.
- To identify clinical, serologic, and bone density differences between these groups.
Main Methods:
- Retrospective analysis of 727 celiac disease patients diagnosed between 1990-2011.
- Severity assessed by villous atrophy, clinical, and serologic markers.
- Multivariable regression adjusted for age and sex.
Main Results:
- 23% of patients presented with anemia (92% iron deficient) vs 77% with diarrhea.
- Anemia presentation associated with lower cholesterol, higher ESR, and higher anti-tissue transglutaminase.
- Anemic patients had higher likelihood of severe villous atrophy and low bone density.
Conclusions:
- Anemia presentation indicates more severe celiac disease compared to diarrhea presentation.
- Sex-specific differences observed in the association between anemia and CD features.
- Anemia as a presentation of celiac disease warrants thorough evaluation for disease severity.
Background & Aims:
Anemia is considered to be an atypical or silent presentation of celiac disease, compared with the classic presentation with diarrhea. However, little information is available about how these groups compare in terms of disease severity. We compared the severity of celiac disease between patients who present with anemia vs those who present with diarrhea.
Methods:
The study cohort was selected from a database of patients with celiac disease who were evaluated at a tertiary referral center between 1990 and 2011. Severity of celiac disease was assessed by the degree of villous atrophy and clinical and serologic parameters. Patients were compared according to mode of presentation and sex. Multivariable analyses, adjusting for age and sex, were conducted to assess the association between the mode of celiac disease presentation and cholesterol level, bone density, severity of villous atrophy, erythrocyte sedimentation rate, and level of anti-tissue transglutaminase.
Results:
Of 727 patients, 77% presented with diarrhea and 23% with anemia (92% iron deficient). On multiple regression analysis, presentation with anemia was associated with lower levels of total cholesterol (P = .02) and high-density lipoprotein (P = .002) and a higher erythrocyte sedimentation rate (P = .001) and level of anti-tissue transglutaminase (P = .01). Presentation with anemia was associated with lower level of cholesterol only in women. Anemic patients were more than 2-fold more likely to have severe villous atrophy and a low bone mass density at the time they were diagnosed with celiac disease than patients who presented with diarrhea.
Conclusions:
Celiac disease patients who present with anemia have more severe disease than those who present with diarrhea. There also appear to be sex-specific differences with regard to the association between anemia and the different features of celiac disease.
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