Resident University of Colorado University of Colorado Denver, Colorado, United States
Background: Patients with celiac disease (CD), a gluten-induced immune-mediated enteropathy, are at increased risk for iron deficiency. Proposed mechanisms include anemia of chronic disease due to systemic inflammation and small bowel enteropathy directly impairing iron absorption. In adults with celiac disease, intestinal healing upon treatment with gluten-free diet (GFD) restores iron levels, independent of iron supplementation. However, there is little evidence on how to best treat iron deficiency in pediatric patients with CD or whether iron supplementation is necessary.
Objective: To measure change in serum hemoglobin and ferritin levels with and without iron supplementation after initiation of a GFD in pediatric patients with newly diagnosed CD.
Design/Methods: We performed a retrospective cohort study of patients diagnosed with CD at the Colorado Center for Celiac Disease between 2009 and 2019 who had laboratory tests performed at diagnosis and 3-6 months at their first follow up visit.. Patients were classified as having CD if they met the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) histopathological criteria or the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) criteria. Demographics, date of diagnosis, initial and follow up hemoglobin, ferritin, and tissue transglutaminase IgA (tTG IgA), medications, other medical diagnoses, and symptom response to GFD were extracted from medical records. As a proxy for GFD adherence, those with improved tTG IgA were then compared based on whether they received iron supplementation or not.
Results: We identified 74 patients with CD diagnosed at our center between 2009 and 2019 who had laboratory tests performed at diagnosis and 3-6 months at their first follow up visit. Of those, 62 had improved tTG IgA. (Figure 1 and Table 1) Iron supplementation did not result in greater improvement in hemoglobin or ferritin levels when compared to patients that were not prescribed iron (unpaired student’s t-test, p > 0.05). Conclusion(s): Patients with CD and presumed adherence to a GFD did not see additional benefit from iron supplementation. This suggests that small intestinal mucosal healing on a GFD alone may be enough to improve iron absorption and iron supplementation may not be warranted. Further prospective studies are needed to better account for adherence to GFD and iron supplementation.
[Figure 1] Study subject flow diagram
[Table 1] Clinical characteristics and iron defficiency data
Authors/Institutions: Paula Dias Maia, University of Colorado, Denver, Colorado, United States; Sadie Nagle, University of Colorado, Denver, Colorado, United States; Mary H. Shull, University of Colorado, Denver, Colorado, United States; Pooja Mehta, University of Colorado, Denver, Colorado, United States; Monique Germone, University of Colorado, Denver, Colorado, United States; Edwin Liu, University of Colorado, Denver, Colorado, United States; Marisa Stahl, University of Colorado, Denver, Colorado, United States
