Significance of low ferritin without anaemia in screen-detected, adult coeliac disease patients

Abstract

Background: Low ferritin without anaemia has been linked to adverse health effects.

Objectives: To investigate the prevalence and clinical significance of low ferritin in screen-detected coeliac disease.

Methods: Seventy-six screen-detected coeliac disease patients were enrolled in the prospective collection of comprehensive clinical, laboratory and histological data at diagnosis and after 1-2 years on a gluten-free diet (GFD). All variables were compared between patients with different ferritin levels.

Results: At coeliac disease diagnosis, six patients had anaemia. Of the 70 nonanaemic patients, ferritin levels were <15 μg/L in 21%, 15-29 μg/L in 19%, 30-99 μg/L in 36% and ≥100 μg/L in 24%. Those with lower ferritin were more often females, had lower body mass index, haemoglobin and villous height-crypt depth ratio and also had higher intra-epithelial lymphocyte CD3+ levels in duodenal biopsies. The groups did not differ in neurological or gastrointestinal symptoms, health-related quality of life, bone mineral density, liver values, vitamin, albumin or coeliac autoantibody levels or the prevalence of comorbidities. Median ferritin levels increased from 41.5 μg/L to 86.0 μg/L on GFD (p < 0.001). Ferritin remained <30 μg/L in 21% of patients but was not associated with dietary compliance, nor was any correlation between changes in ferritin and quality of life, gastrointestinal symptoms, autoantibody levels or degree of histological damage detected.

Conclusion: Decreased ferritin is a frequent finding in screen-detected coeliac disease and may not be fully restored on a GFD. However, low ferritin levels are not associated with more severe symptoms or poorer quality of life.

Keywords: coeliac disease; ferritin; follow-up; quality of life; symptoms.

Fig. 1

(a) Small‐bowel mucosal villous height–crypt depth ratio (VH:CrD) and (b) density of CD3+ intra‐epithelial lymphocytes (IELs) in 70 screen‐detected and nonanaemic patients with different ferritin levels at the time of coeliac disease diagnosis. The values are presented as medians with quartiles (boxes) and range (whiskers). Data were available on 97% of patients.

Fig. 2

Changes in ferritin levels after 1–2 years on a gluten‐free diet (GFD) in patients with initial ferritin levels (a) <15 μg/L, (b) 15–29 μg/L, (c) 30–99 μg/L and (d) >100 μg/L at the time of coeliac disease diagnosis. Ferritin cut‐offs <15 μg/L, <30 μg/L and <100 μg/L are the most used definitions for iron deficiency based on serum ferritin levels, and ferritin ≥100 μg/L a treatment target. Data were available on 89% of patients. Note the different scale on the y‐axis in a–b versus c–d.