Celiac disease(CD) is a disorder characterized by small bowel mucosa(inner layer) damage in people who are genetically predisposed and exposed to Gluten(a storage protein present in barley, wheat and rye and is further divided in to types, Gliadins and Glutelins). It manifests in various systems as a consequence of malabsorption and one of the manifestations is iron-deficiency anemia present in 65-76% of the CD cases and some times is the sole feature making it important to suspect CD in a patient with iron deficiency anemia in a developed country like USA. 3-12% of patients who are investigated with upper gut endoscopy have been found to have CD. It should thus be strongly suspected in a post menopausal female with anemia and in any adult male with anemia.

An anemia is secondary to the decrease in absorption of Iron, Vit. B12 or Folic acid. Since duodenum(first part of small intestine) is the site of iron absorption, failure of iron absorption is secondary to a damage in mucosa(reduced surface of absorption) and this is the most accepted theory as the cause of iron deficiency. Another reason for iron deficiency is an increased chance of chronic(long term)intestinal bleeding in these patients which slowly erodes off the body iron stores and presents as anemia(low hemoglobin) as it gets severe.

The iron deficiency(and thus iron body stores) can be corrected with the institution of a Gluten free diet to the patients.

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