У пациентов с отрицательными серологическими тестами на целиакию нередко выявляется умеренная энтеропатия, которая может быть из-за целиакии, хеликобактерной инфекции или причину установить не удается, если генетические тесты на целиакию отрицательны.
Dig Liver Dis. 2011 Jun;43(6):448-53.
Mild enteropathy as a cause of iron-deficiency anaemia of previously unknown origin.
Monzón H, Forné M, González C, Esteve M, Martí JM, Rosinach M, Mariné M, Loras C, Espinós JC, Salas A, Viver JM, Fernández-Bañares F.
Department of Gastroenterology, Hospital Universitari Mútua Terrassa and Research Foundation Mútua Terrassa, Barcelona, Spain.
BACKGROUND AND AIMS:
We assessed whether mild enteropathy with negative coeliac serology may be gluten-dependent, and a cause of iron-deficiency anaemia. In cases not responding to gluten-free diet, the role of Helicobacter pylori infection was evaluated.
METHODS:
55 consecutive unexplained iron-deficiency anaemia patients were included. In all of them we performed: HLA-DQ2/DQ8 coeliac genetic study, distal duodenum biopsies, and tests to assess H. pylori infection. A gluten-free diet or H. pylori eradication was used as indicated. Final diagnosis was established based on response to specific therapy after a 12-month follow-up period.
RESULTS:
Histological findings were: (1) group A (positive genetics): 21 Marsh I, 2 Marsh IIIA, 12 normal; (2) group B (negative genetics): 16 Marsh I, 4 normal. Final diagnosis of anaemia in patients with enteropathy were: group A, gluten-sensitive enteropathy, 45%; H. pylori infection, 20%; gluten-sensitive enteropathy plus H. pylori, 10%; other, 10%; unknown, 15%; group B, gluten-sensitive enteropathy, 10%; H. pylori infection, 0% (1 non-eradicated case, 10%); non-steroidal anti-inflammatory drug intake, 20%; other, 20%; unknown, 40% (p=0.033).
CONCLUSIONS:
Mild enteropathy is frequent in patients with unexplained iron-deficiency anaemia and negative coeliac serology. Most cases are secondary to either gluten-sensitive enteropathy or H. pylori infection, or both; however, there is also a substantial number of patients without a definitive diagnosis.
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Искренне,
Вадим Валерьевич.
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