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Prevalence of Celiac Disease in Patients With Iron Deficiency Anemia-A Systematic Review With Meta-analysis
Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York New York, United States.
Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York New York, United States.
Department of Medical Sciences, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.ORCID iD: 0000-0003-2247-8454
Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
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2018 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 155, no 2, p. 374-382Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Anemia is common in patients with celiac disease (CD) and a frequent mode of presentation. Guidelines recommend screening patients with iron-deficiency anemia (IDA) for CD. However, the reported prevalence of CD in patients with IDA varies. We performed a systematic review to determine the prevalence of biopsy-verified CD in patients with IDA.

METHODS: We performed a systematic review of articles published in PubMed Medline or EMBASE through July 2017 for the term "celiac disease" combined with "anemia" or "iron deficiency." We used fixed-effects inverse variance-weighted models to measure the pooled prevalence of CD. Meta-regression was used to assess subgroup heterogeneity.

RESULTS: We identified 18 studies composed of 2998 patients with IDA for inclusion in our analysis. Studies originated from the United Kingdom, United States, Italy, Turkey, Iran, and Israel. The crude unweighted prevalence of CD was 4.8% (n = 143). Using a weighted pooled analysis, we found a prevalence of biopsy-confirmed CD of 3.2% (95% confidence interval = 2.6-3.9) in patients with IDA. However, heterogeneity was high (I-2 = 67.7%). The prevalence of CD was not significantly higher in studies with a mean participant age older or younger than 18 years or in studies with a mixed-sex vs female-predominant (>= 60%) population. On meta-regression, year of publication, female proportion, age at CD testing, and prevalence in the general population were not associated with the prevalence of CD in patients with IDA. In the 8 studies fulfilling all our quality criteria, the pooled prevalence of CD was 5.5% (95% confidence interval = 4.1-6.9).

CONCLUSIONS: In a systematic review and meta-analysis, we found that approximately 1 in 31 patients with IDA have histologic evidence of CD. This prevalence value justifies the practice of testing patients with IDA for CD.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018. Vol. 155, no 2, p. 374-382
Keywords [en]
Celiac, Coeliac, Iron Deficiency, Meta-Analysis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-68471DOI: 10.1053/j.gastro.2018.04.016ISI: 000440023400034PubMedID: 29689265Scopus ID: 2-s2.0-85050466232OAI: oai:DiVA.org:oru-68471DiVA, id: diva2:1239052
Note

Funding Agency:

NIDDK NIH HHS  T32 DK083256

Available from: 2018-08-15 Created: 2018-08-15 Last updated: 2018-08-15Bibliographically approved

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Ludvigsson, Jonas F.

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