Anemia en la enfermedad celíaca
Resumen
La anemia es una manifestación frecuente de la enfermedad celiaca en adultos. Por tanto, la sola presencia de anemia hace imperiosa la búsqueda activa de esta patología. La causa de la anemia en la enfermedad celiaca es multifactorial, la ferropénica es la más frecuente. El déficit de hierro puede explicarse por malabsorción, ingesta inadecuada, microsangrados intestinales y además por la descamación del epitelio intestinal. En general no responde a la suplementación oral con hierro, pero sí a la dieta libre de gluten. El déficit de ácido fólico es frecuente también ya que comparte sitio de absorción con el hierro. En pacientes que cumplen la dieta libre de gluten puede perpetuarse por el uso de harinas no suplementadas con el aporte mínimo requerido. Aunque la afectación ileal que provoque déficit de vitamina B 12 es poco prevalente, su déficit no es despreciable en estos pacientes y se asocia a alteraciones en la secreción ácida y al sobrecrecimiento bacteriano que puede estar asociado. La anemia inflamatoria también es una causa para considerar como en cualquier enfermedad crónica. Cursa con inhibición de la eritropoyetina por el estado proinflamatorio y aumento de los niveles de ferritina y hepcidina. En todos los casos el cumplimiento de la dieta libre de gluten es fundamental. En un paciente celiaco que cumple la dieta y persiste con anemia luego de un período considerable, debe considerarse de acuerdo con el contexto, que se trate de enfermedad celíaca refractaria o que exista una complicación. De lo contrario, obliga a buscar diferenciales independientes de la enfermedad celiaca.
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DOI: http://dx.doi.org/10.61155/gen.v75i2.559
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