Гастроинтестинальные факторы риска развития анемии у детей с целиакией

Наталья Сергеевна Шаповалова; Валерия Павловна Новикова; Мария Олеговна Ревнова; Ольга Петровна Гурина; Елена Александровна Дементьева; Ксения Алексеевна Кликунова

Gastrointestinal risk factors for anemia in children with celiac disease

Natalia S. Shapovalova St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation
Valeriya P. Novikova St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation
Maria O. Revnova St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation
Olga P. Gurina St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation
Elena A. Dementieva St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation
Ksenia A. Klikunova St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Abstract

With oral intake, iron absorption in patients with celiac disease (CD) is reduced due to the decreased absorption surface of the atrophic small intestine mucous membrane. Besides, there are additional risk factors for anemia whose mechanisms are unclear. The aim of this study was to evaluate gastrointestinal risk factors for anemia in children. Materials and methods. The first group consisted of 58 children with newly diagnosed CD who did not adhere to the gluten-free diet (GFD). The second group included 49 children with CD who hasn’t been adhering to the GFD. The third group included 69 children with chronic gastritis (CG) without CD. In addition to the standard examination, which includes the determination of antibodies to tissue transglutaminase and histological examination of the duodenum mucous membrane, a histological evaluation of the gastric mucosa, determination of pepsinogen 1 and 2 and their ratio, antibodies to Castle’s intrinsic factor were performed. Results. The mean level of hemoglobin in the group 1 – _114,71120,10_125,50 g/l, in the group 2 – _124,37128,74_133,10 g/l, in the group 3 – _130,12133,78_137,43 g/l (p_1,2 = 0.013; p_1,3 = 0,000; p_2,3 = 0.083). A correlation analysis of the hemoglobin level and morphological parameters of the duodenal mucosa among the studied patients revealed an inverse moderate correlation between the hemoglobin level and the degree of the small intestinal atrophy according to Marsh r = –0.331, p = 0,000, crypt depth r = –0,439, p = 0,000, and a moderate direct with the ratio of villi:crypt r = 0.417, p = 0.000, with the height of the villi r = 0.366, p = 0,000. Additionally, a moderate direct correlation between the level of hemoglobin and the number of parietal cells was found to be r = 0.354, p = 0.037. In group 1, a significant inverse correlation between the level of hemoglobin and the level of antibodies to Castle’s factor r = –0.529, p = 0.006, was obtained for the level of antibodies in the Castle’s factor. Conclusion. Autoimmune gastritis may be an additional risk factor in combination with malabsorption, as a possible cause of anemia in children with CD.