Anemia in Pediatric Celiac Disease: Association With Clinical and Histological Features and Response to Gluten-free Diet

Abstract

Goals: The aim of the present study was to compare clinical, serological, and histological manifestations between children with anemia and without anemia at celiac disease (CD) diagnosis.

Background: Despite being a common finding, the association between the presence of anemia and clinicohistopathological presentation of CD in children remains obscure.

Study: A total of 455 patients with CD <18 years of age were divided into those with anemia and those without anemia at diagnosis. The groups underwent comparisons of a variety of clinical, serological, and laboratory parameters and severity of small-bowel mucosal damage. Furthermore, adherence and clinical and serological response to the gluten-free diet (GFD) were compared.

Results: Anemia was detected in 18.0% of the patients. Children with anemia had higher values for transglutaminase 2 antibodies (120.0 U/L vs 88.0 U/L, P < 0.001) and, by definition, lower values for hemoglobin (10.5 g/dL vs 12.8 g/dL, P < 0.001) and other iron parameters. They were also less often screen-detected (13.4% vs 34.6%), had more severe histological damage (P = 0.048), and poorer dietary adherence (78.3% vs 87.5%, P = 0.035) than the patients without anemia. A total of 92% of the patients recovered from anemia after a median of 1 year on a GFD, but hemoglobin values remained significantly lower compared with the nonanemic group (12.5 g/dL vs 13.2 g/dL, P = 0.045). There was no difference between the groups in the clinical and serological response to the GFD (P = 0.318).

Conclusions: Anemia at CD diagnosis is associated with more severe histological and serological presentation in children. Furthermore, low hemoglobin may not fully recover even after a median of 1 year on a strict GFD.

Trial registration: ClinicalTrials.gov NCT02072590.