Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review Martín Masot, Rafael Nestares Pleguezuelo, María Teresa Díaz Castro, Javier López Aliaga, María Inmaculada Muñoz Alférez, María José Moreno Fernández, Jorge Maldonado Lozano, José Celiac disease Gluten-free diet Iron deficiency Anemia Micronutrient deficiencies Celiac disease (CD) is a multisystemic disorder with di erent clinical expressions, from malabsorption with diarrhea, anemia, and nutritional compromise to extraintestinal manifestations. Anemia might be the only clinical expression of the disease, and iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of CD. Therefore, CD should be suspected in the presence of anemia without a known etiology. Assessment of tissue anti-transglutaminase and anti-endomysial antibodies are indicated in these cases and, if positive, digestive endoscopy and intestinal biopsy should be performed. Anemia in CD has a multifactorial pathogenesis and, although it is frequently a consequence of iron deficiency, it can be caused by deficiencies of folate or vitamin B12, or by blood loss or by its association with inflammatory bowel disease (IBD) or other associated diseases. The association between CD and IBD should be considered during anemia treatment in patients with IBD, because the similarity of symptoms could delay the diagnosis. Vitamin B12 deficiency is common in CD and may be responsible for anemia and peripheral myeloneuropathy. Folate deficiency is a well-known cause of anemia in adults, but there is little information in children with CD; it is still unknown if anemia is a symptom of the most typical CD in adult patients either by predisposition due to the fact of age or because biochemical and clinical manifestations take longer to appear. 2020-01-09T13:47:13Z 2020-01-09T13:47:13Z 2019-10-23 info:eu-repo/semantics/article Martín-Masot, R., Nestares, M. T., Diaz-Castro, J., López-Aliaga, I., Alférez, M. J. M., Moreno-Fernandez, J., & Maldonado, J. (2019). Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients, 11(11), 2557. http://hdl.handle.net/10481/58601 10.3390/nu11112557 eng http://creativecommons.org/licenses/by/3.0/es/ info:eu-repo/semantics/openAccess Atribución 3.0 España MDPI