Brief Articles
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World J Gastroenterol. Jun 14, 2009; 15(22): 2748-2753
Published online Jun 14, 2009. doi: 10.3748/wjg.15.2748
Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women
Lucy Vannella, Debora Gianni, Edith Lahner, Antonio Amato, Enzo Grossi, Gianfranco Delle Fave, Bruno Annibale
Lucy Vannella, Edith Lahner, Gianfranco Delle Fave, Bruno Annibale, Department of Digestive and Liver Disease, Hospital Sant’Andrea, II School of Medicine University Sapienza, 00189 Rome, Italy
Debora Gianni, Antonio Amato, Center for Thalassemic Disease of Rome, 00189 Rome, Italy
Enzo Grossi, Department of Medical Affair, Italian Diagnostic Center, 20100 Milan, Italy
Author contributions: Vannella L analyzed data and wrote the paper; Lahner E analyzed data; Delle Fave G and Amato A, Gianni D collected data; Grossi E and Delle Fave G revised the paper; Annibale B designed research and revised the paper.
Correspondence to: Bruno Annibale, MD, Department of Digestive and Liver Disease, Sant'Andrea Hospital, 1035 Grottorossa Street, 00189 Rome, Italy. bruno.annibale@uniroma1.it
Telephone: +39-6-33775289
Fax: +39-6-4455292
Received: February 10, 2009
Revised: May 5, 2009
Accepted: May 12, 2009
Published online: June 14, 2009
Abstract

AIM: To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori (H pylori) infection and celiac disease in women aged < 50 years affected by iron-deficiency anemia (IDA).

METHODS: One hundred and fifteen women aged < 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies (tTG) and anti-H pylori IgG antibodies. tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay (ELISA). All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum (n = 3), gastric body (n = 3) and duodenum (n = 4) in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh’s System.

RESULTS: 45.2% women were test-positive: 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239). The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test-negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for H pylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active H pylori infection was found. In particular, in 23 out of 28 (82%) patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body.

CONCLUSION: Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.

Keywords: Iron deficiency anemia; Women; Celiac disease; Helicobacter pylori gastritis