COELIAC DISEASE was confirmed in 17.5% of children with anaemia in a small North Indian study, while all biopsy confirmed cases had negative serological screening, raising questions about relying on serology alone when clinical suspicion remains high.
Coeliac disease is an immune mediated enteropathy that can present solely as iron deficiency anaemia, potentially contributing to delayed diagnosis. Researchers investigated its prevalence among children with anaemia and examined associations between coeliac disease and haematological parameters.
The prospective observational study enrolled 40 children aged 4–18 years with anaemia over 21 months at a tertiary care teaching hospital in North India. Anaemia was defined using age specific haemoglobin criteria. Participants underwent clinical evaluation, complete blood count, iron studies, and serological screening for immunoglobulin A anti tissue transglutaminase antibodies. Upper gastrointestinal endoscopy and duodenal biopsy were also performed.
Seven of the 40 children had biopsy confirmed coeliac disease, corresponding to a prevalence of 17.5% (95% CI: 7.3–32.8).
Serum iron and transferrin concentrations were significantly lower among children with coeliac disease than those without: p=0.018 and p=0.041, respectively. However, researchers found no significant association between coeliac disease and sex, anaemia severity, or Helicobacter pylori status.
Notably, all seven children with biopsy confirmed coeliac disease had negative antibody results according to the manufacturer’s threshold. The only positive serological result occurred in a child without coeliac disease.
Girls represented 62.5% of the overall study population.
The researchers reported that the observed prevalence of coeliac disease among children with anaemia was substantially higher than expected in the general population.
However, they emphasised that the findings originated from a small cohort of 40 children at a single centre. Within these limitations, the results suggested that negative serological testing alone may not be sufficient to exclude coeliac disease among children with anaemia when clinical suspicion remains high.
The findings therefore highlighted the potential importance of duodenal biopsy in the diagnostic assessment of selected children with anaemia, particularly when coeliac disease remains clinically suspected despite negative serology.
Reference
Sindhuri TMJ et al. Prevalence of Celiac Disease in the Pediatric Population with Anemia: a Prospective Observational Study from Northern India. Int J Health Sci Res. 2026;16(8):1–11
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