A short review of malabsorption and anemia

Anemia is a frequent finding in most diseases which cause malabsorption. The most frequent etiology is the combination of iron and vitamin B12 deficiency. Celiac disease is frequently diagnosed in patients referred for evaluation of iron deficiency anemia (IDA), being reported in 1.8%-14.6% of patients. Therefore, duodenal biopsies should be taken during endoscopy if no obvious cause of iron defi ciency (ID) can be found. Cobalamin defi ciency occurs frequently among elderly patients, but it is often unrecognized because the clinical manifestations are subtle; it is caused primarily by food-cobalamin malabsorption and pernicious anemia. The classic treatment of cobalamin deficiency has been parenteral administration of the vitamin. Recent data suggest that alternative routes of cobalamin administration (oral and nasal) may be useful in some cases. Anemia is a frequent complication of gastrectomy, and has been often described after bariatric surgery. It has been shown that banding procedures which maintain digestive continuity with the antrum and duodenum are associated with low rates of ID. Helicobacter pylori (H pylori) infection may be considered as a risk factor for IDA, mainly in groups with high demands for iron, such as some children and adolescents. Further controlled trials are needed before making solid recommendations about H pylori eradication in these cases.

Impact of mass screening for gluten-sensitive enteropathy in working population

AIM:To assess:(1)frequency and clinical relevanceof gluten sensitive enteropathy(GSE)detected by serology in a mass screening program;(2)sensitivity of antitransglutaminase(tTGA)and antiendomysium antibodies(EmA);and(3)adherence to gluten-free diet(GFD)and follow-up. METHODS:One thousand,eight hundred and sixtyeight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive,duodenal biopsy,DQ2/DQ8 genotyping, clinical feature recording,blood tests,and densitometry were performed.Since>98%of individuals had tTGA <2 U/mL,this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample.Adherence to a GFD and follow up were registered. RESULTS:Twenty-six(1.39%)subjects had positive tTGA and/or EmA,and 21 underwent biopsy:six Marsh Ⅲ(oneⅢa,fourⅢb,oneⅢc),nine MarshⅠand six Marsh 0(frequency of GSE 1:125).The sensitivity of EmA for GSE was 46.6%(11.1%for MarshⅠ,100% for MarshⅢ),while for tTGA,it was 93.3%(88.8% for MarshⅠ,100%for MarshⅢ).All 15 patients with abnormal histology had clinical features related to GSE.MarshⅠandⅢsubjects had more abdominal pain than Marsh 0(P=0.029),and a similar trend was observed for distension and diarrhea.No differences in the percentage of osteopenia were found between MarshⅠandⅢ(P=0.608).Adherence to follow-up was 69.2%.Of 15 GSE patients,66.7%followed a GFD with 80%responding to it. CONCLUSION:GSE in the general population is frequent and clinically relevant,irrespective of histological severity.tTGA is the marker of choice.Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.