THE PREVALENCE OF OCCULT GASTROINTESTINAL-BLEEDING IN CELIAC SPRUE

Background. Iron deficiency complicating celiac sprue is usually attri buted to the malabsorption of dietary iron or the loss of iron from th e intestinal mucosa, There has been little investigation of the role o f intestinal loss of blood in patients with this condition, The purpos e of this study was to determine the prevalence of occult gastrointest inal bleeding in patients with celiac sprue. Methods. We tested one 48 - or 72-hour stool collection from each of 8 patients with partial vil lous atrophy and 28 patients with total villous atrophy using a guaiac -impregnated card (Hemoccult). Serving as controls were 18 normal subj ects, each studied before and during laxative-induced diarrhea; 17 pat ients with idiopathic chronic diarrhea; 63 patients with microscopic c olitis; 23 patients with pancreatic steatorrhea; and 7 patients with t reated celiac sprue who had normal intestinal histologic features, All the patients underwent a diagnostic workup that included esophagogast roduodenoscopy, colonoscopy, and barium radiography of the small bower . Results. Positive Hemoccult tests were infrequent in each of the con trol groups, occurring in 0 to 8 percent of the subjects, whereas 2 of the 8 patients with partial villous atrophy (25 percent) and 15 of th e 28 patients with total villous atrophy (54 percent) had positive tes ts, When the patients with total villous atrophy were classified accor ding to their subsequent responses to a gluten-free diet, 7 of the 17 who were responsive to gluten withdrawal (41 percent) were Hemoccult-p ositive, as compared with 8 of the 11 who did not respond to the diet (73 percent). Conclusions. Occult gastrointestinal bleeding can be det ected in about half of patients with celiac sprue and should be added to the list of factors that can contribute to iron deficiency in patie nts with this disorder. (C) 1996, Massachusetts Medical Society.