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Anemia in non-celiac wheat sensitivity: Prevalence and associated clinical and laboratory features

  • Author Footnotes
    1 Pasquale Mansueto and Aurelio Seidita equally contributed to the study as first coauthors
    Pasquale Mansueto
    Footnotes
    1 Pasquale Mansueto and Aurelio Seidita equally contributed to the study as first coauthors
    Affiliations
    Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
    Search for articles by this author
  • Author Footnotes
    1 Pasquale Mansueto and Aurelio Seidita equally contributed to the study as first coauthors
    Aurelio Seidita
    Footnotes
    1 Pasquale Mansueto and Aurelio Seidita equally contributed to the study as first coauthors
    Affiliations
    Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
    Search for articles by this author
  • Maurizio Soresi
    Affiliations
    Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
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  • Alessandra Giuliano
    Affiliations
    Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90146, Palermo, Italy

    Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
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  • Giorgia Riccio
    Affiliations
    Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
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  • Umberto Volta
    Affiliations
    Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138, Bologna, Italy
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  • Giacomo Caio
    Affiliations
    Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
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  • Francesco La Blasca
    Affiliations
    Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
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  • Rosaria Disclafani
    Affiliations
    Istituto Zooprofilattico Sperimentale della Sicilia (IZSS), 90129, Palermo, Italy
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  • Roberto De Giorgio
    Affiliations
    Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
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  • Antonio Carroccio
    Correspondence
    Corresponding author at: Internal Medicine, Via Ciaculli 207, 90124, Palermo, Italy.
    Affiliations
    Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90146, Palermo, Italy

    Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
    Search for articles by this author
  • Author Footnotes
    1 Pasquale Mansueto and Aurelio Seidita equally contributed to the study as first coauthors
Published:December 17, 2022DOI:https://doi.org/10.1016/j.dld.2022.11.022

      Abstract

      Background

      Patients suffering from non-celiac wheat sensitivity (NCWS) frequently report extra-intestinal symptoms, such as anemia.

      Aims

      We investigated the prevalence and associated clinical features of anemia in NCWS patients.

      Methods

      Data from 244 NCWS patients, diagnosed by double-blind placebo-controlled wheat challenge, were retrospectively reviewed and compared with 2 control groups (celiac disease (CD) and irritable bowel syndrome (IBS)). Furthermore, 31 NCWS anemic patients were prospectively re-evaluated after at least 12 months on the “strict” wheat-free diet (WFD).

      Results

      Anemia prevalence in NCWS patients was 34.8% (mean hemoglobin 10.4 ± 1.4 g/dl), significantly higher than in IBS (17.4%, P = 0.03), but not in CD ones. The NCWS group, on the whole, had sideropenic-like features with low serum iron and altered iron deposits. Both anemia prevalence and sideropenic-like features were more evident in CD than in NCWS patients, whereas only a few IBS subjects showed such features. Significant differences were found in anemic vs non-anemic NCWS patients as regards to female sex, diagnostic delay, poly/hypermenorrhea, iron deficiency, and higher TSH values. A long-term WFD significantly reduced anemia and improved iron metabolism.

      Conclusion

      Microcytic/hypochromic anemia and altered iron metabolism occur frequently in NCWS and can be treated with a long-term strict WFD. NCWS should be included in differential diagnosis of anemic patients with “functional gastrointestinal troubles”.

      Keywords

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