Letter to the Editor

Screening Veterans Affairs Patients with Iron Deficiency for Celiac Disease

Authors: Rizwan Kibria, MD, Salma Akram, MD, FACG, Syed A. Ali MD, FACG, Khurram Bari, MD, Qasim Khalil, MD, Kanan Sharma, MD


To the Editor:

Upper gastrointestinal tract (GI) endoscopy and colonoscopy are the cornerstones for investigating iron deficiency anemia (IDA).1 If the endoscopic evaluation of the GI tract is equivocal, small bowel (SB) biopsies are routinely obtained to rule out celiac disease (CD). Diagnostic yield of this practice differs in different populations and geographic regions.2 This practice of routine SB biopsies has significant resource implications.3 To date, no one has assessed the usefulness of routine SB biopsies obtained during upper GI endoscopy in Veterans Affairs (VA) patients presenting with IDA.

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1. Schuppan D, Kelly CP. Is duodenal biopsy required in all patients with suspected celiac disease? Nat Clin Pract Gastroenterol Hepatol 2008;5:70–71.
2. Ackerman Z, Eliakim R, Stalnikowicz R, et al. Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol 1996;91:2099–2102.
3. Harewood GC, Holub JL, Lieberman DA. Variation in small bowel biopsy performance among diverse endoscopy settings: results from a National Endoscopic Database. Am J Gastroenterol 2004;99:1790–1794.