While GSE was thought to be a rare disease in the past and was believed to be essentially a disease of Europeans, recent screening studies showed that GSE is one of the most frequent genetically based diseases occured worldwide. Iron deficiency anemia could be a sole manifestation of GSE, and it might result in the delayed diagnosis of GSE, resulting in complications.
A research team led by Prof. Reza Malekzadeh studied the prevalence of gluten sensitive enteropathy (GSE) in a large group of patients with iron deficiency anemia (IDA) of obscure origin. Their findings will be published on December 28, 2008 in the World Journal of Gastroenterology .
In this prospective study, 4120 patients with IDA were enrolled in this study. Anti-endomysial antibody (EMA) and tissue transglutaminase antibody (tTG) levels were evaluated and duodenal biopsies were taken and scored according to the Marsh classification. The diagnosis of GSE was based on a positive serological test and abnormal duodenal histology. Gluten free diet (GFD) was advised for all the GSE patients.
Of the 4 120 IDA patients, 206 (95 male) patients were found to have IDA of obscure origin. Thirty out of 206 patients (14.6%) had GSE. Sixteen patients had Marsh 3, 12 had Marsh 2, and 2 had Marsh 1 lesions. The severity of anemia was in parallel with the severity of duodenal lesions. Twenty-two GSE patients (73.3%) had no gastrointestinal symptoms. Fourteen GSE patients who adhered to GFD without receiving iron supplementation agreed to undergo follow up visits. After 6 mo of GFD, their mean hemoglobin levels (Hb) increased from 9.9 ?± 1.6 to 12.8 ?± 1.0 g/dL (P < 0.01). Interestingly, in 6 out of 14 patients who had Marsh 1/2 lesions on duodenal biopsy, mean Hb increased from 11.0 ?± 1.1 to 13.1 ?± 1.0 g/dL (P < 0.01) while they did not receive any iron supplementation. These results indicate that there is a high prevalence of GSE in patients with IDA of obscure origin. Gluten free diet can improve anemia in GSE patients who have mild duodenal lesions without villous atrophy.
wjgnet/
"Speed and executive functioning are thought to be among the major components of cognitive health," says co-author Roger Dixon, PhD. With Type 2 diabetes a growing concern among adults of all ages, but especially those above age 30, Dixon says that public health programs could check the cognitive status of people with more advanced or severe cases; ensure that diet and medications are effectively employed in all early diagnosed cases; and enact possible cognitive monitoring or training programs for people with diabetes. According to the U.S. Centers for Disease Control and Prevention, new cases of diabetes nearly doubled in the past decade, with nearly one new case for every 100 adults between the years 2005 and 2007.
The normal age-related slowing of thought processes could be exacerbated by diseases such as Type 2 diabetes, says Dixon. But, he continues, "There could be some ways to compensate for these declines, at least early and with proper management." The level of impairment detected, he adds, should not make it hard for people to manage their condition.
Diabetes is a known risk factor for late-life neurodegenerative diseases such as Alzheimer's. Although the deficits detected in the current sample were not clinically significant, they appear (according to subsequent research by the authors) to foreshadow additional deficits. Only further study would reveal whether it's possible to "connect the dots" between mild early deficits in speed and executive function, and later signs of a progressive cognitive impairment.
apa/