Celiac Disease and Unexplained Iron Deficiency in a Primary Care Setting
The purpose of this study is to determine if patients with unexplained iron deficiency have underlying diseases processes such as celiac disease.
It is hypothesized that selectively screening patients with unexplained iron deficiency will reveal previously undiagnosed etiologies, including celiac disease and other causes of iron malabsorption along with various sources of occult GI blood loss.
|Study Design:||Observational Model: Cohort|
|Official Title:||Celiac Disease and Unexplained Iron Deficiency in a Primary Care Setting|
- Positive results for Expanded Celiac Disease Panel [ Time Frame: Upon consent and enrollment in the study, laboratory tests will be done to evaluate for the presence of Celiac Disease ] [ Designated as safety issue: No ]Expanded Celiac Disease Panel includes TTG-IgG, TTG-IgA, AntiGliadin-IgG, AngtiGliadin-IgA, and Total Serum IgA
- Percentage of Clinic Patient Population with one or more markers of iron deficiency [ Time Frame: at enrollment ] [ Designated as safety issue: No ]Other tests will be done at enrollment to assess for iron malabsorption and possibly to identify causes of iron malabsorption other than celiac disease. These include Iron absorption Testing (serum iron level before and after oral FeSO4 tablet or liquid), with percent iron saturation. Ferritin, Hemoglobin and Hematocrit, Vitamin D level, Folate, Vitamin B12 level, Aspartate Aminotransferase (AST), and Stool Occult Blood Test
- Improved Quality of Life after one year of intervention (either gluten-free diet if Celiac disease is diagnosed and/or recommendation of daily iron supplementation) [ Time Frame: Enrollment and End of One Year ] [ Designated as safety issue: No ]For patients diagnosed with Celiac disease at enrollment, a gluten-free diet will be advised explained by a Registered Dietician. Patients not diagnosed with celiac disease but with iron deficiency or malabsorption will be advised to take daily oral iron supplements. Quality of Life Surveys will be administered at enrollment and at the end of one year to assess for improvement resulting from diet and/or supplementation.
Biospecimen Retention: Samples Without DNA
The serum remaining from 10 mL of blood will be aliquoted and frozen at -70 degrees. If future funding allows, these samples will be tested for autoimmune and malabsorption markers.
|Study Start Date:||March 2014|
|Study Completion Date:||January 2015|
|Primary Completion Date:||January 2015 (Final data collection date for primary outcome measure)|
The primary purpose of the study is to document unexplained iron deficiency and its relationship to celiac disease, iron malabsorption and occult intestinal blood loss. Test results given to primary care physicians may prompt further testing for celiac disease (duodenal biopsy) or other potential causes of occult iron deficiency. The specific endpoints to be evaluated include:
- Prevalence of specific serum markers of celiac disease in those with unexplained serum markers of iron deficiency.
- Prevalence of iron malabsorption with and without celiac disease in the same population
- Frequency of other blood tests for malabsorption and their association with celiac disease or other cause of iron malabsorption.
- Frequency of specific historical markers associated with celiac disease
- Prevalence of unrecognized GI blood loss
- Quality of life improvement based on new diagnoses with appropriate therapy
- After one year follow-up, review patient records for additional diagnoses explaining iron deficiency.
Discover several etiologies of unexplained iron deficiency in a primary care clinic population including celiac disease, iron malabsorption and occult intestinal blood loss.
- Define percent of total clinic patient population with one or more markers of iron deficiency on last testing and the subset without an apparent etiology on their problem list ("study group").
- Define percent of patients in the study group that are currently iron deficient at time of study onset, and how many of those are actually anemic.
- Define percent of study group patients with iron malabsorption, with or without celiac disease.
- Document improved quality of life outcomes for those with new diagnoses and appropriate therapy, including celiac disease given gluten-free diet and iron therapy.
- For those patients identified with celiac disease, do statistical analysis of historical and lab parameters that are more highly linked to celiac disease to improve screening parameters.
- Document percent of various diagnoses that explain occult iron deficiency as found by primary care providers over the course of a one year follow-up after initial diagnosis. (Providers will be given all testing results related to their patients after the initial screening and at one year.)
- Specific cost-effectiveness of this screening procedure may be done in a future study if preliminary results are suggestive of improved outcomes.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02036944
|United States, Washington|
|Providence Medical Research Center|
|Spokane, Washington, United States, 99204|
|Principal Investigator:||Samuel Palpant, MD||Providence Internal Medicine Residency Services|