Doença celíaca causa 4% das enxaquecas 
Migraine Linked to Celiac Disease

Laurie Barclay, MD

March 25, 2003 — About 4% of migraine sufferers may have celiac disease and symptom control may be improved with a gluten-free diet, according to the results of a study published in the March issue of the American Journal of Gastroenterology.

"If larger, randomized, controlled trials confirm these preliminary findings, serological screening for celiac disease could be proposed as part of management of migraine, and the gluten-free diet as the first-line therapy in the subgroup of patients with evidence of celiac disease," write Maurizio Gabrielli, MD, from Gemelli Hospital in Rome, Italy, and colleagues.

Of 90 patients diagnosed with idiopathic migraine, four (4.4%; 95% confidence interval [CI], 1.2 - 11.0%) had celiac disease, compared with 0.4% of 23 blood donors used as controls (95% CI, 0.01 - 2.3; P < .05). These four patients were treated with a gluten-free diet for six months. During that time, one had no migraine attacks, and migraine frequency, duration, and severity improved in the other three. All four patients had resolution of baseline regional reduction in brain tracer uptake on single-photon emission computed tomography scan.

"The improvement observed in both symptoms and cerebral blood flow after a gluten-free diet is intriguing," the authors write, noting that in this uncontrolled study, placebo effect could not be ruled out. "It needs to be clarified, however, whether celiac disease itself is associated with cerebral blood flow abnormalities, or whether these flow alterations are present only in those patients with both celiac disease and migraine. Also, one might argue that migraine has different underlying mechanisms in individuals who are affected by celiac disease versus those who are not."
                                                  Am J Gastroenterol. 2003;98:625-629

                                                      Reviewed by Gary D. Vogin, MD

Segundo esse estudo, em cerca de 4% dos portadores de enxaqueca (migrânia), a causa do problema pode ser doença celíaca, ou alergia a gluten -      

Colaboração do Dr. Stefano Jorge

Doença celíaca em 3% das anemias ferroprivas 

Celiac Disease Present in About 3% of Patients With Iron-Deficiency Anemia

News Author: Laurie Barclay, MD

Feb. 12, 2004 — Celiac disease is present in about 3% of patients with iron-deficiency anemia, according to the results of a prospective trial published in the January issue of the Southern Medical Journal. The investigators recommend panendoscopy and screening for this treatable condition in unexplained cases.
"Occult celiac disease has been reported in 0 to 6% of adults presenting with iron-deficiency anemia," write Umaprasanna S. Karnam, MD, and colleagues from the University of Miami School of Medicine in Florida. "Most prior studies have been retrospective or screened only a selected population of patients with small bowel biopsies."

From 1998 to 2000, all patients seen at the University of Miami for iron-deficiency anemia, including those with hemoccult-positive stools, had esophagogastroduodenoscopy with small bowel biopsies and colonoscopy, including more than two biopsies of the distal duodenum. Iron-deficiency anemia was defined as serum ferritin less than 25 ng/mL and hemoglobin less than 12 g/dL for women and less than 14 g/dL for men.

Patients with documented prior erosive, ulcerative, or malignant disease of the gastrointestinal tract, previous gastrointestinal surgery, overt gastrointestinal bleeding within the past three months, or inability to access the duodenum for biopsy were excluded. Patients with a positive small bowel biopsy had a serum immunoglobulin A antiendomysial antibody test to confirm the diagnosis of celiac disease.

Of 139 consecutive patients with iron-deficiency anemia, 105 patients met the inclusion criteria and were enrolled, including 57 men (mean age, 51.6 years) and 48 women (mean age, 54.1 years). Demographic composition was 36 blacks, 38 Hispanics, 22 whites, and nine patients of mixed or unknown ethnic background. Hemoccult-positive stools were present in 40.9% of study subjects overall; in 43.8% of the men, and in 37.5% of the women.
Upper endoscopy revealed gastritis in 22.8% of the patients, gastric ulcers in 9.5%, duodenitis in 8.5%, esophagitis in 7.6%, Barrett's ulcer in 2.8%, duodenal ulcer in 2.8%, gastric polyp in 2.8%, and celiac disease in 2.8%. Colonoscopic findings were polyps in 21.9%, diverticula in 10.4%, and hemorrhoids in 16.1%. Multiple findings were present in 32.3% of patients, whereas 28.5% of patients had no findings.

"The prevalence of occult celiac disease in this prospective study of patients presenting with iron-deficiency anemia was 2.8%. A significant number of other gastrointestinal lesions amenable to therapy were also found on upper and lower endoscopy in these patients," the authors write. "Given the treatable nature of celiac disease, it should be screened for in patients with unexplained iron-deficiency anemia with or without hemoccult-positive stools."

                                                           South Med J. 2004;97:30-34

Os achados evidenciam a necessidade de pesquisar a doença em portadores de anemia por carência de ferro, com ou sem sangue oculto nas fezes.

Colaboração do Dr. Stefano Jorge