International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2018, 6(1), 26-29
DOI: 10.12691/ijcd-6-1-2
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Iron refractory or Iron Resistant Iron Deficiency Anemia in Adult Celiac Disease Resolves with a Gluten-free Diet

Hugh James Freeman1,

1Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, Canada

Pub. Date: April 02, 2018

Cite this paper:
Hugh James Freeman. Iron refractory or Iron Resistant Iron Deficiency Anemia in Adult Celiac Disease Resolves with a Gluten-free Diet. International Journal of Celiac Disease. 2018; 6(1):26-29. doi: 10.12691/ijcd-6-1-2


Iron deficiency anemia is a common presentation of adult celiac disease. In a retrospective review of over 200 adults with celiac disease complicated by iron deficiency anemia, 7 patients were selected that were treated either with oral iron supplements with a limited hematologic response or unable to tolerate oral iron. Subsequently, treatment with a strict gluten free diet alone was provided. In all, resolution of the anemia resulted without a need for concomitant oral iron supplements. Another patient with marked fatigue and exercise intolerance was treated with intravenous iron, but the iron deficiency anemia only partially improved. After a strict gluten-free diet, her iron deficiency anemia resolved completely. Clinical experience in these celiac patients indicates that the key element in the treatment of iron deficiency anemia is a positive intestinal mucosal response to a gluten-free diet. In celiac patients with iron deficiency anemia, particularly with a limited hematologic response, intolerance or side effects to iron supplements, treatment solely with a gluten-free diet may be a reasonable option. Iron deficiency anemia in celiac disease is heterogeneous and may have multiple causes. Although duodenal mucosal disease is a critical factor, other factors may alter the regulation of iron homeostasis in this setting, including altered erythropoiesis due to the underlying chronic intestinal inflammatory process.

adult celiac disease iron deficiency anemia iron refractory anemia gluten-free diet

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