Reprinted from Eating Disorders Review
November/December 2012 Volume 23, Number 6
©2012 Gürze Books
Q. Since many young patients with anorexia nervosa complain about a variety of unusual gastrointestinal symptoms, I’ve wondered whether these patients should be routinely screened for the possibility of celiac disease and gluten enteropathy. Is any evidence available to offer guidance on whether or not this sort of screening might be worthwhile? (FA, Los Angeles)
A. Your interesting idea has been examined in Rome by a research group who conducted their study on the neuropsychiatric unit in a large tertiary care children’s hospital. Their sample involved 177 consecutively admitted patients with anorexia nervosa, including 33 males and 144 females (average age: 14.5 years), 32% of whom had abdominal complaints on admission. These patients were all screened for celiac disease by means of serologic testing for IgA and IgG class anti-transglutaminase antibodies in the presence of IgA deficiency, with histological follow-up performed if the serological tests were positive.
Only one patient in this series was found to have celiac disease that was confirmed by intestinal biopsy. This patient was started on a gluten-free diet and her weight was ultimately restored to enable her to recover from amenorrhea, but this intervention did not affect her abnormal feeding behavior. Notably, during weight restoration and follow-up, digestive complaints regressed in all the patients.
Since the overall prevalence of celiac disease among the anorexia nervosa patients was 0.6 %, similar to that observed in the general population, these authors concluded that routine screening for celiac disease is not warranted for patients with anorexia nervosa (Eur J Pediatr 2012 Oct 17. [Epub ahead of print]; PMID: 23073902). If no other specific reasons to suspect celiac disease exist, we’re much better off not wasting clinicians’ time or patients’ money.
– J.Y.
