Daijiworld Media Network - New Delhi
New Delhi, Aug 11: Coeliac disease was confirmed in 17.5% of children with anaemia in a small study conducted at a tertiary care teaching hospital in North India, with researchers cautioning that negative blood tests alone may not be sufficient to rule out the condition when clinical suspicion remains high.
The prospective observational study, conducted over 21 months, involved 40 children aged four to 18 years with anaemia. The children underwent clinical evaluation, complete blood counts, iron studies and serological screening for immunoglobulin A anti-tissue transglutaminase antibodies. Upper gastrointestinal endoscopy and duodenal biopsy were also performed.
Seven of the 40 children were confirmed to have coeliac disease through biopsy, giving a prevalence of 17.5%, with a 95% confidence interval of 7.3% to 32.8%.
Coeliac disease is an immune-mediated disorder affecting the small intestine and can sometimes present primarily as iron deficiency anaemia, potentially leading to delayed diagnosis.
A notable finding was that all seven children with biopsy-confirmed coeliac disease had negative antibody results according to the manufacturer's threshold. The only positive serological result was recorded in a child who did not have coeliac disease.
Researchers found that serum iron and transferrin levels were significantly lower among children with coeliac disease than those without the condition, with p-values of 0.018 and 0.041, respectively. However, no significant association was found between coeliac disease and sex, severity of anaemia or Helicobacter pylori status. Girls accounted for 62.5% of the overall study population.
The researchers said the prevalence of coeliac disease observed among children with anaemia was substantially higher than expected in the general population. However, they cautioned that the findings were based on a small cohort of 40 children from a single centre.
The study nevertheless suggests that negative serological testing alone may not be sufficient to exclude coeliac disease among children with anaemia when clinical suspicion remains high. The researchers highlighted the continued importance of duodenal biopsy in selected cases, particularly when coeliac disease is suspected despite negative serological results.