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The prevalence of occult gastrointestinal bleeding in celiac sprue.

Abstract

BACKGROUND

Iron deficiency complicating celiac sprue is usually attributed to the malabsorption of dietary iron or the loss of iron from the intestinal mucosa. There has been little investigation of the role of intestinal loss of blood in patients with this condition. The purpose of this study was to determine the prevalence of occult gastrointestinal bleeding in patients with celiac sprue.

METHODS

We tested one 48- or 72-hour stool collection from each of 8 patients with partial villous atrophy and 28 patients with total villous atrophy using a guaiac-impregnated card (Hemoccult). Serving as controls were 18 normal subjects, each studied before and during laxative-induced diarrhea; 17 patients with idiopathic chronic diarrhea; 63 patients with microscopic colitis; 23 patients with pancreatic steatorrhea; and 7 patients with treated celiac sprue who had normal intestinal histologic features. All the patients underwent a diagnostic workup that included esophagogastroduodenoscopy, colonoscopy, and barium radiography of the small bowel.

RESULTS

Positive Hemoccult tests were infrequent in each of the control groups, occurring in 0 to 8 percent of the subjects, whereas 2 of the 8 patients with partial villous atrophy (25 percent) and 15 of the 28 patients with total villous atrophy (54 percent) had positive tests. When the patients with total villous atrophy were classified according to their subsequent responses to a gluten-free diet, 7 of the 17 who were responsive to gluten withdrawal (41 percent) were Hemoccult-positive, as compared with with 8 of the 11 who did not respond to the diet (73 percent).

CONCLUSIONS

Occult gastrointestinal bleeding can be detected in about half of patients with celiac sprue and should be added to the list of factors that can contribute to iron deficiency in patients with this disorder.

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  • Authors+Show Affiliations

    Department of Gastrointestinal Research. Baylor University Medical Center, Dallas, TX 75246, USA.

    Source

    The New England journal of medicine 334:18 1996 May 02 pg 1163-7

    MeSH

    Adolescent
    Adult
    Aged
    Case-Control Studies
    Celiac Disease
    Feces
    Female
    Gastrointestinal Hemorrhage
    Hemoglobins
    Humans
    Intestine, Small
    Iron
    Male
    Middle Aged
    Occult Blood
    Prevalence

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    8602182

    Citation

    Fine, K D.. "The Prevalence of Occult Gastrointestinal Bleeding in Celiac Sprue." The New England Journal of Medicine, vol. 334, no. 18, 1996, pp. 1163-7.
    Fine KD. The prevalence of occult gastrointestinal bleeding in celiac sprue. N Engl J Med. 1996;334(18):1163-7.
    Fine, K. D. (1996). The prevalence of occult gastrointestinal bleeding in celiac sprue. The New England Journal of Medicine, 334(18), pp. 1163-7.
    Fine KD. The Prevalence of Occult Gastrointestinal Bleeding in Celiac Sprue. N Engl J Med. 1996 May 2;334(18):1163-7. PubMed PMID: 8602182.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The prevalence of occult gastrointestinal bleeding in celiac sprue. A1 - Fine,K D, PY - 1996/5/2/pubmed PY - 1996/5/2/medline PY - 1996/5/2/entrez SP - 1163 EP - 7 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 334 IS - 18 N2 - BACKGROUND: Iron deficiency complicating celiac sprue is usually attributed to the malabsorption of dietary iron or the loss of iron from the intestinal mucosa. There has been little investigation of the role of intestinal loss of blood in patients with this condition. The purpose of this study was to determine the prevalence of occult gastrointestinal bleeding in patients with celiac sprue. METHODS: We tested one 48- or 72-hour stool collection from each of 8 patients with partial villous atrophy and 28 patients with total villous atrophy using a guaiac-impregnated card (Hemoccult). Serving as controls were 18 normal subjects, each studied before and during laxative-induced diarrhea; 17 patients with idiopathic chronic diarrhea; 63 patients with microscopic colitis; 23 patients with pancreatic steatorrhea; and 7 patients with treated celiac sprue who had normal intestinal histologic features. All the patients underwent a diagnostic workup that included esophagogastroduodenoscopy, colonoscopy, and barium radiography of the small bowel. RESULTS: Positive Hemoccult tests were infrequent in each of the control groups, occurring in 0 to 8 percent of the subjects, whereas 2 of the 8 patients with partial villous atrophy (25 percent) and 15 of the 28 patients with total villous atrophy (54 percent) had positive tests. When the patients with total villous atrophy were classified according to their subsequent responses to a gluten-free diet, 7 of the 17 who were responsive to gluten withdrawal (41 percent) were Hemoccult-positive, as compared with with 8 of the 11 who did not respond to the diet (73 percent). CONCLUSIONS: Occult gastrointestinal bleeding can be detected in about half of patients with celiac sprue and should be added to the list of factors that can contribute to iron deficiency in patients with this disorder. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/8602182/The_prevalence_of_occult_gastrointestinal_bleeding_in_celiac_sprue_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM199605023341804?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -