Celiac disease in children with refractory iron deficiency anemia: a prospective observational study

Celiac disease (CD) is an immune-mediated enteropathy triggered by dietary gluten in genetically susceptible individuals. Refractory iron deficiency anemia (RIDA) may be the sole presentation of CD in children. This study aimed to investigate the prevalence of CD in this group of patients. This prospective observational study was conducted over a period of 1 year at a tertiary care center of North India. Children aged 6 months to 14 years with refractory IDA were enrolled. Those with positive serology for CD underwent upper gastrointestinal endoscopy and histopathological examination. Out of 65 enrolled RIDA cases, the prevalence of CD was 23.0% (15/65). Significantly higher proportion of celiac RIDA had stunting (93.3% vs. 44.0%) and wasting (93.3% vs. 40.0%) as compared to undifferentiated RIDA. Clinical features such as lethargy, refusal to feed, vomiting, chronic diarrhea, failure to thrive, short stature, and abdominal distention were more frequent in Celiac RIDA cases. Anti-transglutaminase levels between celiac RIDA cases and undifferentiated RIDA cases were found to be statistically significant (p value < 0.001). Abnormal endoscopic findings were observed in 15 out of 23 cases (65.21%) consistent with CD, while the remaining 8 (34.78 %) had normal upper GI endoscopy findings. A significant proportion of children with refractory IDA have underlying CD, often without classical gastrointestinal manifestations. This significant prevalence value justifies the practice of testing patients with RIDA for CD.